Acute hepatitis C virus in an HIV clinic: a screening strategy, risk factors, and perception of risk.
Open accessAbstract
Acute hepatitis C virus (HCV) infection is being acquired undetected among HIV-infected individuals. A practical way to regularly screen HIV-infected patients for acute HCV irrespective of perceived risk or symptoms is needed. We piloted implementation of an acute HCV screening strategy using routine HIV clinical care schedules and the least costly blood tests, in a Rhode Island HIV care center. Study participants had ongoing HCV risk, completed questionnaires encompassing risk behaviors and perception of risk, and were screened with quarterly alanine aminotransferase (ALT). ALT rise triggered HCV RNA testing, with pooled rather than individual specimen HCV RNA testing for underinsured participants. Participants were primarily older, college-educated men who have sex with men (MSM) with history of sexually transmitted infection other than HIV. One of 58 participants developed acute HCV in 50 person-years of observation for an annual incidence of 2.0% per year (95% confidence interval [CI] 0.05-11.1%). The majority (54%) of MSM did not perceive that traumatic sexual and drug practices they were engaging in put them at risk for HCV. Unprotected sex often occurred under the influence of drugs or alcohol. Self-reported HCV risk and participation in several risk behaviors declined during the study. It was possible to collect frequent ALTs in a busy HIV clinic with 71% of total projected ALTs obtained and 88% of participants having at least one ALT during the 9-month follow-up period. All instances of ALT rise led to reflexive HCV RNA testing. Tracking quarterly ALT for elevation to systematically prompt HCV RNA testing before seroconversion is a promising approach to screen for acute HCV in a real-world HIV clinical setting.
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Screening for HCV in this setting is cost-effective.
“Screening for HCV in this setting is cost-effective (238,239).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [239]
The Discussion says pooled HCV RNA testing may be more cost-effective than testing individual specimens, but only under certain incidence conditions. It also states that this pilot study did not perform a cost analysis, so it does not establish that screening in this setting is cost-effective. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIncreasing incidence of acute HCV infection among MSM with HIV infection has been reported in multiple U.S. and European cities.
“Increasing incidence of acute HCV infection among MSM with HIV infection has been reported in multiple U.S. (96,236,239,1339) and European cities (237,1340–1342).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [239]
The Introduction describes increasing incidence of acute HCV among HIV-infected MSM and calls it globally significant. The Methods and Abstract describe a study in one U.S. city, Providence, but the paper does not document an increasing trend across multiple U.S. or European cities. (LLM, conf=0.83)
Experimental — accuracy not yet measuredRegular screening of persons with HIV for HCV is cost-effective.
“Because acute HCV infection acquisition among persons with HIV infection can occur, especially among MSM, and regular screening of those with HIV is cost-effective (238,239,1377), periodic HCV screening should be conducted (1378–1380).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [239]
The Discussion describes regular HCV screening in HIV care as feasible and discusses ways to reduce testing costs. It explicitly states that no cost analysis was performed, so this paper does not establish that regular screening is cost-effective. (LLM, conf=0.87)
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La personalidad médica de Maimónides
Capdevila, J. G. (1935) · Universidad de Córdoba Insitutional Repository (Universidad de Córdoba)
- Authors
- Taylor, L. E., DeLong, A. K., Maynard, M. A., Chapman, S., Gholam, P., Blackard, J. T., Rich, J., & Mayer, K. H.
- Affiliations
- Brown University (US)
- Miriam Hospital (US)
- Case Western Reserve University (US)
- University of Cincinnati (US)
- Corresponding author
- Taylor, L.E.
- Venue
- AIDS Patient Care and STDs
- Publisher
- SAGE Publications
- Published
- 2011-10
- Volume
- 25
- Issue
- 10
- Pages
- 571-577
- ISSN
- 1087-2914 (ISSN-L)
- 1557-7449
- PMC
- PMC3183653
- OpenAlex
- W2159291252
- Cited by
- 24
- References
- 40
- Citations by year
- 2021: 2 · 2018: 1 · 2017: 1 · 2016: 6 · 2015: 2 · 2014: 4 · 2013: 4 · 2012: 2
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- AIDS Patient Care and STDs (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (AI42853)
- Center for AIDS Research, University of Washington (P30AI042853, P30 DA013868)
- National Institute on Drug Abuse (P30DA013868, K23DA020383)
- National Institute of Allergy and Infectious Diseases (P30AI042853)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- acute hepatitis C, HIV coinfection, HCV screening, alanine aminotransferase, HCV RNA testing, group testing, risk perception, men who have sex with men, sexually transmitted infections, drug use, unprotected sex, seroconversion, HIV care centers
- MeSH terms
- Acute Disease, Adolescent, Adult, Alanine Transaminase, Ambulatory Care Facilities, Female, Hepatitis C, Humans, Health Knowledge, Attitudes, Practice, Male, Mass Screening, Middle Aged, Surveys and Questionnaires, Rhode Island, Risk, Risk Factors, Sexual Behavior, Sexually Transmitted Diseases, HIV Infections, Hepacivirus, Homosexuality, Male, Young Adult
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