We studied hepatitis C virus (HCV) and human immunodeficiency virus (HIV) dynamics in 10 coinfected subjects in a trial of pegylated interferon-alpha2a (PEG-IFN) alone or combined with ribavirin (RBV), compared with IFN plus RBV for the treatment of HCV. Five subjects, 4 of whom were treated with PEG-IFN, achieved a sustained virological response, although it was delayed by >/=1 week in 3 subjects. The median treatment efficacy in blocking virion production was 99.7% in the PEG-IFN group and 60% with standard IFN. In 2 patients with detectable HIV loads before starting HCV study drugs, we observed a 1-log decrease in HIV RNA load. The estimated HCV virion half-life was longer in the HIV-coinfected subjects, which suggests that coinfection may contribute to a slower clearance of HCV. Although the early viral kinetics of coinfected subjects treated with PEG-IFN or IFN differ from those of singly infected subjects, the treatment response seems unaffected.

An ethnographic field study about the informed consent process in investigational drug trials for seriously ill persons with hepatitis C suggests that nurses and physicians referred to these trials as giving treatment, even though they involved placebos. Interview data and informed consent documents contained frequent references to the term ;treatment trial' or ;treatment'. Although these findings were unexpected and not the original focus of our study, we consider them in the light of an extensive literature on the ;therapeutic misconception' that has been described among physicians and patients with AIDS and other serious illnesses. We also suggest that certain organizational and professional characteristics of nursing and medicine reinforce this tendency to refer to the trials as treatment. Implications for further research are provided.

Background Anal high-grade squamous intraepithelial lesion (aHSIL) is the immediate precursor of anal cancer. Anal cytology is a recommended screening test to identify aHSIL among people with HIV (PWH). Heterogeneity of risk for invasive anal cancer among PWH suggests the value of a shared decision-making framework regarding screening. Methods Using a longitudinal HIV cohort with a comprehensive anal cancer screening program, we estimated the adjusted probabilities of having aHSIL on the first anal cytology. We used logistic regression models with inverse-probability weighting to account for differential screening in the cohort and to construct a predicted probability nomogram for aHSIL. Sensitivity analysis was performed to estimate aHSIL prevalence corrected for misclassification bias. Results Of 8139 PWH under care between 2007 and 2020, 4105 (49.8%) underwent at least one anal cytology test. First-time cytology aHSIL was present in 502 (12.2%) PWH. The adjusted probability of having aHSIL varied from 5% to 18% depending on patient characteristics. Prespecified factors in the aHSIL prediction model included nadir CD4 cell count, ethnicity, race, age, sex, gender identity, and HIV risk factors. The ability of the model to discriminate cytological aHSIL was modest, with an area under the curve (AUC) of 0.63 (95% CI%: 0.60-0.65). Conclusion PWH are at increased risk for aHSIL and invasive anal cancer. Risk, however, varies by patient characteristics. Individual risk factors profiles predictive of aHSIL can be modeled and operationalized as nomograms to facilitate shared decision-making conversations concerning anal cancer screening.

Despite primary prevention efforts to educate the public about hepatitis C, the most prevalent blood-borne human disease in the world today, most Americans remain unaware of their infection status. Widespread screening programs established to identify those at risk have been slow to emerge and difficult to implement, especially when compared to the nation's rapid response to the HIV/AIDS epidemic. Analysis of screening and testing practices among nurses and other clinicians within the Veterans Affairs Administration (VA), the site of the most comprehensive hepatitis C virus outreach program to date, reveals numerous barriers to reaching at-risk veterans. It is worthwhile to examine the VA experience for lessons in how to identify other Americans at risk, particularly those without access to primary care in well-funded, organized systems of care.

This article presents a set of observations on some of the ways in which individuals come to learn that they are infected with the hepatitis C virus (HCV). In doing so, we draw on field data collected in a study of informed consent in HCV clinical research and published reports on HCV surveillance and testing. The concept of illness trajectory is used to illustrate the process of disease discovery. Various circumstances, some related and some unrelated to HCV symptoms, initiate the illness trajectory and the diagnostic search for HCV disease. We borrow the concept of “The Accidental Tourist” to illustrate the unexpected journey of HCV disease discovery. We conclude by considering some implications of the diagnostic search phase of the HCV trajectory for HCV social policy, clinical care, and future research.