Acute hepatitis C: courses under eight weeks cured fewer

Design

Systematic review and meta-analysis of mostly single-arm studies

Population

1,078 people treated for acute or recently acquired hepatitis C in 14 studies

Primary outcome

Sustained virological response at 12 weeks

Effect

Pooled cure 97.7%; 84.8% at 4 weeks, 91.7% at 6 weeks, 99.4% at 8 weeks

This meta-analysis pooled 14 studies of two-drug direct-acting antiviral regimens for acute or recently acquired hepatitis C, covering 1,078 treated patients, many of them men who have sex with men living with HIV or people who inject drugs.

Overall, 97.7% were cured (sustained virological response at 12 weeks). Cure depended on duration: 84.8% at four weeks, 91.7% at six weeks, 99.4% at eight weeks and 97.4% at twelve weeks. Regimen and HIV status made no difference.

Most studies were single-arm, and regimen and duration overlapped, so this does not settle the ideal course. But it argues against experimenting with ultra-short regimens outside trials, and supports treating promptly rather than waiting to see if the infection clears.

• Offer treatment for acute or recent hepatitis C promptly rather than waiting for spontaneous clearance.
• Use a course of at least eight weeks; four- and six-week courses cured fewer.
• Results were similar with and without HIV co-infection.
• Retest HCV RNA after treatment and periodically if risk continues; reinfection is common in these groups.

Why it matters

Short courses are tempting for adherence, but the evidence says eight weeks is the floor.

Don't overread it

No randomised trial here compared durations directly.

The statistics, in plain English

Pooled single-arm results tell you how often cure happened, not a head-to-head comparison. The duration differences are large, but because different studies used different regimens and durations, part of the gap could come from regimen rather than length.

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