When to start treatment for acute hepatitis C virus in HIV-positive individuals?
Although HIV-infected individuals are less likely to spontaneously clear acute HCV infection than HIV-negative individuals, spontaneous eradication can occur [66,82-84,112]. It is still not clear how long should a patient be observed to allow for this possibility before commencing therapy. In a randomized study of acute HCV monoinfection in Egypt, SVR rates were compromised by a delay in start of PEG to 20 weeks from time of first positive HCV-RNA test result (76% SVR), but were similar in those starting 8 (95% SVR) or 12 (92% SVR) weeks after diagnosis [101]. The majority of patients in this study were infected through occupational exposure and it should be noted that in this study, a short duration of 12 weeks of treatment only was used. In HCV monoinfection, a ‘watch and wait’ policy of 12 weeks before commencing treatment is advised, and current guidelines on HIV-positive individuals similarly recommend waiting 12 weeks from estimated date of exposure to ensure that spontaneous cle
