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Acute HCV Treatment in HIV — SCE Infectious Diseases MCQ

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ModerateHepatitisAcute HCV Treatment in HIVSCE Infectious Diseases

A 30-year-old man with HIV on ART develops hepatitis C after needle-sharing. He now has acute HCV (HCV RNA positive, anti-HCV seroconversion documented within the last 6 months). His genotype is 1a. Should treatment be offered for acute HCV or should he wait for chronic HCV?

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Correct answer: B — Treat acute HCV — current guidelines recommend DAA treatment for acute HCV to prevent chronicity and onward transmission; Sofosbuvir/Velpatasvir or Glecaprevir/Pibrentasvir for 8 weeks

EASL 2024 guidelines recommend treating acute HCV with DAAs rather than awaiting spontaneous clearance, particularly in HIV-co-infected patients (who have lower spontaneous clearance rates — ~15% vs ~25% in HIV-negative). Early treatment prevents chronic HCV development, liver disease progression, and onward transmission. Standard pangenotypic DAA regimens (Sofosbuvir/Velpatasvir 12 weeks or Glecaprevir/Pibrentasvir 8 weeks) are used. Interferon is no longer recommended. Harm reduction counselling to prevent reinfection is essential.

Reference: EASL 2024 – HCV guidelines; BHIVA 2024 – HCV/HIV