The Spectrum of Undiagnosed Hepatitis C Virus Infection in a US HIV Clinic

Abstract

United States guidelines endorse one-time HCV antibody screening at HIV diagnosis. Rescreening HCVseronegative patients on a regular basis is still not policy, although HIV-infected persons have reasonably substantial HCV incidence. We evaluated routine risk factor-independent HCV antibody re-testing in a Rhode Island HIV clinic. We instituted annual HCV antibody testing for HCV-seronegative patients who had not been rescreened in a year or more. Testing based on clinical suspicion continued. We conducted a chart review of new antibody-positive cases in the first year of rescreening, July 2006 to June 2007. Of 245 rescreened patients, 11 (4.5%) seroconverted. Five (45%) were female. Median time between last negative and first positive result was 32 months (range 8-98 months). Six (55%) had documented risk factors and 6 (55%) elevated ALT ( > 45 IU/L) between antibody tests; none prompted re-testing. One seroconverter died of hepatocellular carcinoma 3.7 years after HCV diagnosis. A twelfth was rescreened for suspected acute HCV based on ALT of 515 IU/L. He had newly detectable HCV RNA then seroconversion, and achieved SVR following 6 months of treatment in the acute phase for genotype 1 infection. Incident HCV is not uncommon among HIV-infected patients in care. Rescreening identified undiagnosed HCV in this population. HCV RNA should be checked promptly in HCV-seronegative persons with ALT elevation. We observed consequences of late diagnosis (hepatocellular carcinoma) and benefits of early diagnosis (cure with treatment of acute HCV). Adding annual rescreening to the Ryan White Program would facilitate earlier identification of undiagnosed HCV and create an instant widespread surveillance system, providing HCV incidence data.

Sexually transmitted infections in HIV-infected people in Switzerland: cross-sectional study

“…STI prevalences in HIV-infected heterosexual men and women in our study were more similar to those in HIV-uninfected people. Although these patient groups are less willing than MSM to endorse routine STI testing, a sexual health assessment offers opportunities for offering hepatitis B vaccination to non-immune individuals, early treatment for hepatitis C ( Taylor et al, 2014 ) and to find out about the reproductive health needs of HIV-infected women ( Fakoya et al, 2007 ).…”

Treating Hepatitis C in a Ryan White-Funded HIV Clinic: Has the Treatment Uptake Improved in the Interferon-Free Directly Active Antiviral Era?

“…1 Hepatitis C virus (HCV) and HIV have shared routes of transmission, and high rates of new HCV infections have been demonstrated in HIV-infected men who have sex with men (MSM). 2 Although annual screening for the HCV antibody is recommended for this atrisk population, at least 50% of all HCV-infected individuals remain undiagnosed. 3 Of those with known HIV/HCV coinfection, very few individuals historically have received treatment for HCV.…”

Hepatitis C Screening in People With Human Immunodeficiency Virus: Lessons Learned From Syphilis Screening

“…One clinic in Australia found that a simple modification in the process of ordering follow-up laboratory results on PLWH dramatically increased screening and diagnosis of syphilis [ 34 ]. There are also some centers interested in developing system-based practices to improve repeat HCVAb testing in PLWH [ 22 ]. At our institution, we have been working with the information systems department to modify our current electronic ordering system to facilitate ordering repeat HCVAb tests in PLWH with previously negative HCVAb.…”