Acute Hepatitis C

Authors: Emily Darby, MD David H. Spach, MD

Last updated: July 11, 2013

A 19-year-old man presents to the clinic for follow-up after being seen in the emergency department 2 nights prior for a narcotic overdose. Medical history reveals that he started using intravenous heroin 2 months ago and has shared needles with several acquaintances. Review of systems is negative. He is a thin, slightly disheveled man with mild scleral icterus. A review of laboratory studies from the emergency room visit reveals a normal complete blood count, a normal basic metabolic panel, an alanine aminotransferase (ALT) level of 380 U/L, and a bilirubin of 4 mg/dL. He denies significant alcohol use or any history of liver disease. Several years ago, he completed the hepatitis B vaccine series. Given his recent exposure, acute hepatitis C virus infection is strongly suspected.

Which of the answers below are TRUE regarding this patient and the diagnosis and treatment of acute hepatitis C?

A Fewer than 30% of patients with acute hepatitis C virus infection will have symptoms associated with the acute infection.
B The cellular immune system plays a minor role in the clearance of the hepatitis C virus during acute infection.
C If this patient has acute hepatitis C, his chances of clearing the infection without therapy are less than 5%.
D If therapy is initiated for acute hepatitis C, most experts would recommend using a combination of peginterferon and ribavirin for 1 year.