Efficacy of direct-acting antiviral regimens for acute HCV infection: a systematic review and meta-analysis.
Nada Mansour, Ramy M F Elbarody, Ahmed M Kamel
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In 30 seconds
This systematic review and meta-analysis assessed interferon-free dual direct-acting antiviral regimens for acute or recently acquired HCV infection. Across 14 studies and 19 single-arm analysis units, 1078 treated patients had a pooled SVR12 of 97.7% (95% CI 94.7-99.1; 1043/1078; I² = 30.4%). Cure rates differed by treatment duration: pooled SVR12 was lower with 4- or 6-week courses than with 8- or 12-week courses. Rates did not differ significantly by regimen, study design, or HIV status. The authors favour at least eight weeks of treatment, while noting that randomised duration comparisons are needed.
Key findings
- Pooled SVR12 was 97.7% (95% CI 94.7-99.1; 1043/1078; I² = 30.4%).
- SVR12 was 84.8% (74.1-91.6) at 4 weeks and 91.7% (86.2-95.1) at 6 weeks, versus 99.4% (97.5-99.9) at 8 weeks and 97.4% (91.7-99.2) at 12 weeks (between-subgroup p < 0.001).
- SVR12 did not differ by regimen (p = 0.608), study design (p = 0.764), or HIV status (p = 0.975).
Why it matters
Acute and recently acquired HCV occurs in populations where early cure may benefit individuals and help limit transmission. The high pooled SVR12 supports the effectiveness of dual-DAA therapy in the included evidence, while the duration findings caution against assuming that very short courses achieve comparable cure rates. Clarifying optimal duration is important for balancing treatment length with reliable viral clearance.
What to keep in mind
Evidence was predominantly from single-arm studies, and regimen was partly confounded with treatment duration; randomised duration-comparison trials are needed.