These patients could have spontaneously cleared their infection if HCV therapy
had been deferred. Some authors have proposed waiting 12 weeks, not from the diagnosis but from the estimated date of exposure, before beginning HCV therapy.5 Deferring HCV therapy a few months from the date of exposure may be confusing, because the date of exposure may be uncertain, and because the time between exposure and diagnosis often exceeds several months. In the same way, deferring HCV therapy a few months from the date of diagnosis may be misguided, considering the low rate of spontaneous clearance we observed 3 months later in our 21 patients who were Epigenetics Compound Library chemical structure uncensored at this time. Because it is likely that each month spent with uncontrolled HCV replication and the evolution toward chronic hepatitis C would contribute to a reduction in the response rate to further anti-HCV Erastin concentration therapy, as shown in HIV-negative patients,17 it is likely that there is no real benefit to postponing HCV therapy more than 3 months after the diagnosis of acute hepatitis C. In addition, it has been reported that the spontaneous disappearance
of HCV RNA could be temporary, but nevertheless could lead to chronic hepatitis C,13 even though this was not observed in our study. This finding could swing the pendulum toward immediate or at least earlier treatment of acute hepatitis C, because the overall SVR following HCV therapy in our homogeneous cohort of HIV-infected MSM was 81.6% (and was as high as 83.3% when considering only the 39 patients treated with PEG-IFN
and ribavirin). This rate is higher than that initially reported in HIV-infected patients (50%-71%)10, 13, 16, 18, 19 but is very close to that reported in two recent studies (78%-80%).8, 20 Several factors could explain this high rate, such as the use of combination therapy, satisfactory safety, and/or the frequent use of psychiatric or hematological supportive measures as recommended for HCV therapy in chronic hepatitis, and/or the duration of treatment Morin Hydrate longer than 24 weeks in half of the cases (and even longer than 52 weeks for 20% of them). It should also be noted that no significant association between pretreatment parameters (including HCV genotype) and SVR was observed. However, it has to be acknowledged that the impact of other factors, in particular IL28B polymorphism, which has been shown to have a strong impact on chronic hepatitis C treatment outcomes in HIV-infected patients, was not studied in the present study.21 In HCV monoinfected patients, a few trials have shown that PEG-IFN monotherapy could be associated with high response rates (72%-94%).22-25 In the same way, the study of Vogel et al.13 in 36 HIV-infected patients showed a nonsignificant trend toward a better virological response in patients on PEG-IFN monotherapy compared with those with added ribavirin.