We thank De Rosa and colleagues for their comments highlighting that timing of treatment and compliance are major issues in the treatment of acute hepatitis C. We fully agree that treatment of IVDUs with acute hepatitis C is difficult and that earlier treatment may have advantages in certain settings. However, some centers have reported different experiences in the treatment of acute hepatitis C in IVDUs. The results reported from Italy1 are not in line with experiences in Switzerland showing that barriers to interferon-alpha therapy are higher in intravenous drug users than in other patients with acute hepatitis C.2 We have to stress that patients with ongoing drug abuse were excluded from our study.3 Nevertheless, our experiences in patients with previous drug abuse are also more in line with the Swiss data than with the study by de Rosa et al. demonstrating the importance of thorough patient selection and close monitoring during therapy in the treatment of acute hepatitis C.
Optimal timing and duration of treatment in acute hepatitis has been discussed controversially for several years.4 In the Italian study treatment was initiated within 34 days (range: 7-116) of the ALT level peak.1 Considering that the ALT peak occurs usually 4 to 8 weeks after infection, the start of therapy was not different from our study (76 days after infection, range: 14-150 days). We are currently comparing early treatment and delayed treatment in a prospectitve randomized multicenter trial in the German Hep-Net.5 Before this study answering the question on optimal timing of treatment of acute hepatitis C is completed, we would recommend to make decisions on an individual patient basis considering factors such as HCV genotype, severity of symptoms, patients compliance and HCV-RNA kinetics.4