What is the treatment for acute Hepatitis C (HCV) exposure in a healthcare worker?

From the Guidelines

For healthcare workers with acute hepatitis C exposure, immediate consultation with an infectious disease specialist is recommended, and if HCV infection is confirmed, prompt treatment with a DAA regimen such as sofosbuvir/velpatasvir for 12 weeks should be initiated, as this regimen has been shown to have a high SVR rate of 95% in patients with recently acquired hepatitis C 1. The standard approach involves baseline HCV RNA testing at the time of exposure, followed by repeat testing at 4-6 weeks to detect early infection. Some key points to consider in the management of acute hepatitis C exposure include:

• Post-exposure prophylaxis with direct-acting antivirals (DAAs) is not routinely recommended, as there is insufficient evidence supporting their effectiveness in this setting 1.
• If HCV infection is confirmed (positive HCV RNA), treatment should be initiated promptly to prevent progression to chronic infection and reduce the risk of liver damage 1.
• Counseling should be provided to patients with acute HCV infection to avoid hepatotoxic insults, including hepatotoxic drugs and alcohol consumption, and to reduce the risk of HCV transmission to others 1.
• The choice of DAA regimen and duration of treatment should be individualized based on the patient's specific circumstances, including the presence of any underlying medical conditions and the potential for drug interactions 1. Key considerations in the treatment of acute hepatitis C include:
• The use of sofosbuvir/velpatasvir for 12 weeks has been shown to be effective in patients with recently acquired hepatitis C, with a high SVR rate of 95% 1.
• Other DAA regimens, such as glecaprevir/pibrentasvir, may also be effective, but the optimal duration of treatment is not well established 1.
• Regular laboratory monitoring is recommended to detect spontaneous clearance and to monitor the response to treatment 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment for Acute Hepatitis C Exposure

• The treatment for acute hepatitis C exposure to healthcare workers is primarily focused on testing and clinical management, rather than postexposure prophylaxis (PEP) 2, 3, 4, 5.
• According to the CDC guidance, baseline testing of the source patient and healthcare worker should be performed as soon as possible, preferably within 48 hours after the exposure 2.
• The testing algorithm for the source patient includes two options:
  • Testing with a nucleic acid test (NAT) for HCV RNA, which is preferred if the source patient is known or suspected to have recent behaviors that increase risk for HCV acquisition 2.
  • Testing for antibodies to hepatitis C virus (anti-HCV), then if positive, testing for HCV RNA 2.
• For healthcare workers, baseline testing for anti-HCV with reflex to a NAT for HCV RNA if positive should be conducted as soon as possible, preferably within 48 hours after the exposure 2.
• Follow-up testing is recommended based on the source patient's status, with testing for HCV RNA at 3-6 weeks postexposure and a final test for anti-HCV at 4-6 months postexposure if HCV RNA is negative 2.
• Postexposure prophylaxis of hepatitis C is not recommended for healthcare workers who have occupational exposure to blood and other body fluids 2, 3, 4.
• However, some studies have explored the use of direct-acting antivirals (DAAs) for PEP, but the low feasibility of conducting an adequately powered clinical trial and the low cost-effectiveness of such an intervention make it not supportive of targeting limited resources for such use 4.
• Innate immune responses, including natural killer T (NKT) and NK cells, may play a role in preventing acute infection in healthcare workers exposed to small amounts of HCV 6.