Acute Hepatitis C in HIV-Positive Individuals

Due to the asymptomatic nature of acute hepatitis C it can be difficult to diagnose in the early stage ofinfection, but with the higher treatment success rates and reduced treatment duration at this stage,it is imperative that diagnoses are made. Therefore, physicians should routinely screen at-risk individualsand investigate abnormal liver function tests. Serum HCV RNA should be considered in anyHCV-antibody-negative individual in whom acute HCV is clinically suspected, or annually in thosehigh-risk individuals with previous infection. Acute hepatitis C transmission may be facilitated by thepresence of an erosive genital lesion, such as syphilis or lymphogranuloma venereum, and thus testingat this time should be encouraged. Reinfection with HCV does occur and patients need to be informedof the sexual and other high-risk behaviors that put them at risk of reinfection. Public awareness ofthe possibility of HCV infection, and subsequent reinfection, in high-risk groups should be increased. Thequestion of the optimal treatment regimen is still disputed. However, ongoing trials and the proposedrandomized controlled trial from the European AIDS Treatment Network should answer many of ourquestions. In the meantime, units faced with HIV/acute hepatitis C coinfection should follow recommendationsfrom the HCV-HIV International Panel.