Since 1991, the routine screening of blood products has decreased the prevalence of acute HCV following
transfusion to negligible levels. Therefore, acute HCV infection is now seen mainly in individuals who have received an accidental needle stick injury. Although a risk for infection is relatively low at < 5%, because the majority of these individuals are health care workers, every effort should be made to make an early diagnosis, and thereby minimize the risk of nosocomial transmission. There are no data to indicate which testing algorithms, using serological tests or PCR assays, are more cost effective. HCV RNA may become positive as early as 2 weeks after exposure. Anti-HCV usually becomes positive 10 weeks after exposure. There has been a suggestion that early treatment of acute hepatitis C with interferon monotherapy C may enhance the likelihood of response compared to chronic hepatitis C (85-87). There is no information as to whether this is true for interferon and ribavirin. The possibility of an enhanced response to early therapy has to be balanced against the theoretical 20% chance of spontaneous clearance of the virus. No recommendations can be made about the timing of therapy of acute hepatitis C. The following recommendation is therefore based on expert opinion, rather than evidence from the medical literature. Healthcare workers or others subjected to needle-stick injury or equivalent exposure should be tested by anti-HCV at the time of the injury and at 12 weeks or later to detect infection. Treatment should be with standard combination therapy of interferon and ribavirin for the standard duration despite the lack of prospective studies proving efficacy. Given the urgent need to gather data on such cases it is strongly recommended that patients with acute hepatitis C be treated in the setting of a clinical trial or a registry.