There are two phases of hepatitis C infection—acute and chronic. Acute refers to a new hepatitis C infection that is less than six months old. Hepatitis C infections that last more than six months, are considered chronic. The reason there are two phases is because approximately 15 to 25 percent of people who are infected with hepatitis C are able to clear the virus from their bodies. They do this on their own, without any medication. Because of their robust immune systems, infants and young women are more likely than others to clear hepatitis C spontaneously.

When someone is newly infected with hepatitis C, the common practice in the U.S. is to wait and see if the infection spontaneously clears. Why spend time and money on an infection that might go away if you wait a bit? Although that sounds reasonable, perhaps this assumption needs to be tested.

Emily Bethea and colleagues analyzed this and published their findings in Hepatology (Should we treat acute hepatitis C? A decision and cost-effectiveness analysis, January 24, 2018). Using a simulation model, they examined the differences between initiating hepatitis C treatment in the acute versus the chronic phase.

The Bottom Line: Dr. Bethea’s team found that when treating acute hepatitis C using direct-acting antivirals (DAAs), the clinical outcomes were better. They also found that treating acute hepatitis C was cost-saving compared with delaying treatment until the chronic phase of infection. The savings were even greater in cases where there was risk of transmitting hepatitis C, such as in situations where people shared drugs and drug use equipment.  

Recommendation: Clinical trials are beginning to show data using shorter 6-week treatment durations. If these prove to be successful, this would reduce the cost of treatment. Under these circumstances, these researchers suggest re-examining current hepatitis C treatment guidelines to incorporate recommendations that account for the clinical and economic benefits of treating acute hepatitis C infection using of DAAs.