The optimal timing and regimen for acute hepatitis C treatment is unclear due to a lack of data with IFN-free DAA therapies. In the setting of IFN-based therapy, acute HCV infection can be treated with shorter and simpler therapeutic regimens, to give a similar or even greater SVR than in chronic HCV infection. This paradigm is unproven in the setting of IFN-free DAA therapies and is the subject of ongoing research studies. If spontaneous clearance has not occurred by 6 months after presentation, the person can be considered to have chronic HCV infection and treated according to current DAA treatment guidelines. Treatment can be considered earlier in specific situations, including in occupationally infected health care workers. Further, there may be a population-level benefit from treating early to prevent ongoing transmission events, particularly in communities such as PWID and HIV-positive MSM.
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. If treatment with DAA-based therapy is considered in the first 6 months after HCV infection, a standard duration of 8–12 weeks should be applied, or the patient entered into a research study pending further data (note that the PBS criteria for treatment specify chronicity as a criterion for eligibility).
There is no place for the use of post-exposure prophylaxis with antiviral therapy after HCV exposure. 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.