People with HIV are not often tested for hepatitis C virus (HCV) infection, according to the American Clinical Infectious Diseases. The retrospective study examined screening practices in seven areas of care between primary and 2000 2011. The frequency of testing increased, but the practice varies considerably among sites, and in some cases individuals with high-risk behavior were often not tested for HCV.
"Testing for HCV incidence varies between sites and the improvement in the frequency of screening is also variable, underscoring the need for US-based guidelines to inform practices of HIV," the authors write.
An editorial in the same journal issue reinforces the importance of early diagnosis of HCV in people with HIV.
Many people with HIV have a high risk of infection with hepatitis C. The injection drug use is a recognized risk factor for acquiring HCV and there is also an epidemic of sexually transmitted HCV among patients with HCV gay men in some cities in Europe and USA.
American guidelines recommend that people with HIV are at high risk of HCV should be considered for annual screening for antibodies against HCV. However, the definition of high risk is unclear and practices of current tests are unknown. Due to this uncertainty, a group of researchers has developed a retrospective study involving 70.000 people with HIV who received primary care in seven sites across the United States and 2000 2011. They measured levels of screened using antibodies or HCV RNA tests as requirements for care, and for people who did not have HCV as standard, levels of subsequent tests. Factors associated with testing were also analyzed, and the researchers also examined whether elevated levels of liver enzymes (ALTs) - a possible indication of recent HCV infection - caused additional diagnostic tests.
The rates of screening in people recently enrolled for care were good with 85% undergoing tests with antibodies or HCV RNA tests within three months after you connect to a carrier. But analysis of 9000 people who do not have HCV and who remained in care for at least one year showed that only 56% had no additional screening during the monitoring of HCV.
Rates of follow-up testing varied among sites from a low of 35% to a high of 79%.
A number of risk factors and clinical features were associated with testing for HCV during follow-up. These include reports of unprotected anal intercourse (OR = 1.31; 95% CI, 1.08-1.59); use of amphetamines (OR = 1.86; 95% CI, 1.42-2.44); have AIDS diagnosis (OR = 1.16; 95% CI, 1.04-1.31); and a history of non-HCV liver disease (OR = 3.41; 95% CI, 2.51-4.63). People who reported injecting drugs were more likely to be screened than gay men or heterosexual risk groups.
Surveillance in screening increased over time and between 2008 and 2011 index ranged between 0.24 screening and screening for people 0.63 year. The average number of screens per person also increased at most sites, as well as the proportion of people who underwent HCV testing at fixed periods.
"Supervision in screening for occurrence of HCV infection varies substantially between clinical sites - even among those who report high-risk features such as current use of amphetamines and anal sex with variable condom use," the authors note.
Screening for HCV in people with elevated ALTs was infrequent: only 27% of people with levels above 100 and one-fifth of those with measures above 400 iu / ml underwent HCV or RNA antibody tests within a period of twelve months. Screening rates were similar when the analyzes were restricted to gays or other men who had sex with men.
"It seems that providers in the United States do not routinely use ALT as a screening test for the occurrence of HCV," comment the investigators. They conclude that guidelines are needed to screen for HCV nationwide for people with HIV, "stating who should attend this screening, how often and which screening tests should be used."
Freiman JM et al. Current practices of screening for incident hepatitis C virus infection among HIV-infected, HCV-uninfected individuals in primary care. Clin Infect Dis, online edition, 2014.
Reiberger T Acute hepatitis C virus infection in HIV+ MSM: should we change our screening practice? Clin Infect Dis, online edition, 2014.
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I think people should be tested for HCV whenever they are found to be HIV-positive, as they are already tested for tuberculosis in similar cases
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