Consensus recommendations for treatment of people with acute HCV infection

Consensus recommendationsGrade
There is no place for the use of post-exposure prophylaxis with antiviral therapy after HCV exposure.B1
A single HCV RNA level below the limit of detection should not be taken as an indication of clearance; at least two undetectable HCV RNA test results, a minimum of 1 month apart, are required before clearance can be confirmed.A1
If spontaneous clearance has not occurred by 6 months after presentation, a person can be considered to have chronic HCV infection and treated according to current DAA treatment guidelines.B1
The optimal timing and regimen for acute hepatitis C treatment is currently unclear due to a lack of data with IFN-free DAA therapies.B2
In the situation where a decision has been made to commence therapy early, within the first 6 months after infection, it is still recommended to hold treatment by monitoring HCV RNA for 12–16 weeks to determine that spontaneous clearance is unlikely.B1
If treatment with DAA-based therapy is considered in the first 6 months after HCV infection, treatment regimens in line with recommendations for chronic HCV infection should be used (note that the PBS criteria for treatment specify chronicity as a criterion for eligibility).B1
Following acute HCV infection, all individuals should undergo risk behaviour education and discussion regarding the possibility of reinfection risk after spontaneous or treatment-induced clearance.B1
Individuals with ongoing risk factors for HCV reinfection should be screened annually for HCV infection with HCV RNA (PCR).A1

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