CDC Makes Acute Hep C Window Bigger

On January 1, 2016 the CDC updated its clinical criteria for an Acute HCV diagnosis.1 Up until then, if someone were to clear hep C on their own the common belief was: 1) it would happen within the first 6 months and 2) roughly 15-25% people would do so. There is some information showing 24% of people who inject drugs and 15% of HIV+ men who have sex with men will spontaneously clear hep C on their own. If a person does not spontaneously clear hep C, then they would develop chronic hepatitis C.

CDC Changes Window From within 6 Months to within 1 Year

Now, maybe I’ve been living under a rock, and this was common knowledge, but I didn’t become aware of the shift from 6 months to 1 year until earlier this month while leading a training in Ohio. I’m sure there are a lot of reasons for the change and I might be making it a bigger deal than it is (clearly, since I’m only noticing it a year and a half later) and truthfully there is a lot of discussion on the apparent disconnect of the CDCs clinical criteria and what can be reported as a confirmed case. However, I think it has important effects on how we continue to find and treat hep C. As I was trying to figure out why the window would be changed and what the benefits or drawbacks are; my gut reaction was there must be some recent reliable study showing a good number of people are clearing the virus after 6 months. Or that several people are spontaneously clearing chronic hep C after that time frame without treatment.

Looking to the Data for Answers

After spending some time looking around it seems that data is mounting showing that very well be the case. A recent study presented at the 2017 European Association for the Study of the Liver Conference shows the chance of clearing acute hep C among people co-infected with HIV was 20% at 1 year, 24% and 29% at 2 and 3 years respectively.2 Clearance rates were also highest among people with genotype 1. All of these rates are higher than previously reported, which makes this a promising study. Having a hep C RNA test that confirms infection is an important first step in treatment. Before we can know if someone has cleared hep C successfully on their own, or with medical treatment, there need to be two negative hep C RNA tests 6 months apart. I think the recent information of an increased chance at clearance beyond the 6 month, or even 1 year mark, is great. More than anything, I think this gives further support to the idea hep C surveillance still has a lot of flaws and gaps. What we know is changing every day and this is a good thing.

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