The HEP-NET study recently published in HEPATOLOGY1 showed that a 24-week course of PEG-IFN (1.5 μg/Kg/weekly) alpha-2b was associated with a SVR of 71% in patients with acute hepatitis C (AHC). Treatment was initiated after spontaneous viral clearance (“late-treatment”) was excluded and the SVR rate was similar to that we achieved with a 12-week regimen of PEG-IFN alpha-2b administered without waiting for the spontaneous viral clearance (“early treatment”).2 Compliance in the HEP-NET study was a major issue and we would like to comment on the early and late treatment strategies of AHC.
In our study, including 19 patients of whom 14 were asymptomatic and 11 patients were infected with genotype 1, the SVR was dosage-dependent as it was significantly associated by multivariate analysis only with PEG-IFN at a dosage ≥1.33 μg/Kg/weekly.2 The SVR rate was 74%; 100% and 83.3%, respectively, in genotype 1 and non–1 infected patients treated with a dosage ≥1.33 μg/Kg. Treatment was administered within 34 days (range: 7-116) of the ALT level peak, and the majority of patients were intravenous drug users (IVDUs).
Observations from these two studies show that a SVR is significantly associated with high PEG-IFN dosage in early treatment whereas the SVR may be significantly affected by the compliance in late treatment. Moreover, the effectiveness of late treatment administered for 8, 12 and 24 weeks was investigated in another study recently published in HEPATOLOGY and showed that the SVR rate increased with the duration of treatment.3 The SVR rates, when AHC was treated for 8, 12 and 24 weeks, were 67.6%, 82.4% and 91.2%, respectively.
Further proof of the importance for early treatment is that negative plasma HCV-RNA was observed 2.5 weeks after the beginning of treatment. We believe this length of time may be shortened since our patients received a variable dosage of PEG-IFN ranging from 1.06 to 1.66 μg/Kg/weekly.4 The less time needed to clear HCV-RNA, the lower the intrahepatic viral load.
These studies may not indicate the best choice between early or late treatment strategies. However, we all know that compliance is a major issue in IVDUs as most of them do not understand the reasons to wait for a possible spontaneous viral clearance. Therefore, we believe that the benefits of early treatment with high PEG-IFN dosages are greater than those achievable by the late treatment, especially in IVDUs.