- Design
- Systematic review and meta-analysis of mainly single-arm studies
- Population
- 1,078 patients with acute or recently acquired hepatitis C treated with dual DAAs
- Primary outcome
- SVR12 overall and by treatment duration
- Effect
- Pooled SVR12 97.7% (94.7–99.1); 4 weeks 84.8%, 6 weeks 91.7%, 8 weeks 99.4%, 12 weeks 97.4%
This meta-analysis pooled 14 studies, mostly single-arm, of interferon-free dual direct-acting antiviral therapy in 1,078 patients with acute or recently acquired hepatitis C. These infections cluster in people who inject drugs and in men who have sex with men living with HIV.
Overall cure (SVR12) was 97.7%. It depended on duration: 84.8% with 4 weeks, 91.7% with 6 weeks, 99.4% with 8 weeks and 97.4% with 12 weeks. Regimen, study design and HIV status made no clear difference.
Treating acute infection early cures the individual and interrupts transmission in the networks where it spreads. These data suggest that 8 weeks is the shortest course that reliably cures, and that ultra-short courses lose about one patient in seven. The evidence is mainly single-arm and regimen was partly confounded with duration, so randomised duration trials are still needed.
- Treat acute or recently acquired hepatitis C early rather than waiting for chronicity; it cures and limits onward spread.
- Plan at least 8 weeks of dual DAA therapy; 4- and 6-week courses cured noticeably fewer in these studies.
- Test for reinfection in people with ongoing risk after cure, as well as checking SVR12.
- HIV co-infection did not lower cure rates here; check antiretroviral interactions before choosing the regimen.
- Offer harm reduction alongside treatment, since reinfection risk persists after cure.
Why it matters
It sets a practical floor on how far treatment of acute infection can be shortened.
Don't overread it
These are pooled single-arm studies, not trials comparing durations directly.
The statistics, in plain English
The 4-week cure rate of 84.8% has a 95% interval of 74.1% to 91.6%, while the 8-week rate is 99.4% (97.5–99.9%); the intervals do not overlap, which makes the duration difference unlikely to be chance. But because different studies used different regimens for different lengths, part of that difference may come from the drugs rather than the time.
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