Acute Hepatitis C Virus in an HIV Clinic: A Screening Strategy, Risk Factors, and Perception of Risk

Abstract

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, collegeeducated 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.

Hepatitis C Virus Awareness Among Men Who Have Sex With Men in Southwest Switzerland

“…25 In the United States, among 58 HIV-positive MSM with HCV risk factors, 54% rated their HCV risk as not high. 26 In Australia, among a small sample of HIV-positive MSM newly coinfected with HCV, two-thirds demonstrated limited knowledge of HCV risk. 27 To our knowledge, ours is the first study to examine HCV awareness among predominantly HIV-negative MSM in Switzerland.…”

Factors Associated With Hepatitis C Infection Among HIV-Infected Men Who Have Sex With Men With No Reported Injection Drug Use in New York City, 2000–2010

“…27,28 Furthermore, there is evidence that HCV infection carries stigma within the HIV-infected MSM community, which may lead to partners not disclosing their HCV status before engaging in high-risk sexual activity. 29 To our knowledge, serosorting based on HCV status is not commonly practiced.…”

High rate of seronegative HCV infection in HIV-positive patients

“…Early diagnosis is rare and the extent of this epidemic is unknown, since the majority of at-risk individuals are not tested for acute HCV infection (5). These and several other aspects of HCV infection may be further complicated by co-infection with HIV-1.…”