Hepatitis C Virus Viremia in HIV-Infected Individuals With Negative HCV Antibody Tests

Abstract

Hepatitis C virus (HCV) viremia may occur in persons without detectable HCV antibodies and has been reported in as many as 5.5% of HIV-positive persons. To better characterize serosilent HCV infection, the authors prospectively tested 131 HIV-positive persons and 102 HIV-negative control subjects with diabetes for the presence of HCV antibody (Ab) and HCV RNA. Thirty of 31 HCV Ab-positive (AbP) HIV-positive people tested positive for HCV RNA as did both HCV AbP, HIV-negative control subjects. Similarly, none of the 100 HIV-negative, HCV Ab-negative (AbN) control subjects was HCV RNA positive (p<.001). In contrast, 19 of 100 HIV-positive, HCV AbN persons met stringent criteria for HCV viremia, and 9 of these 19 people were HCV RNA positive when tested by a commercially available HCV RNA detection method. The mean duration of HCV viremia in HCV AbN people was 26.8 months (range, 1-99 months). None of the subjects developed HCV antibody during the study. The HIV-positive, HCV AbP, and RNA-positive group was significantly more likely to have acquired HIV parenterally (p<.001), have higher initial CD4 counts (p=.029), and have higher ALT values than the HCV AbN group (p<.002). In summary, HCV infection appears to occur more frequently among HIV-infected, HCV-seronegative persons than appreciated, especially if HIV acquisition was through sexual as opposed to parenteral risk factors and was associated with a lower initial CD4 count and lower ALT values.

Effect of serostatus for hepatitis C virus on mortality among antiretrovirally naive HIV-positive patients

“…First, the HCV data were based on serologic testing alone and not confirmed with polymerase chain reaction testing. Roughly 5% of seronegative people will have detectable HCV RNA, 23 and 5%-10% of HIV-infected patients who are HCV seropositive will nevertheless have undetectable HCV RNA; 24 this suggests that the potential for misclassification bias is minimal. Second, our measure of adherence was restricted to the first year of therapy; this was done explicitly to avoid the possible reverse-causation that may result from patients who become less adherent to their ART because they are too sick to take the medications.…”

Hepatitis C seropositivity is not a risk factor for sensory neuropathy among patients with HIV

“…We therefore cannot exclude an association between neuropathy and HCV viremia or chronic liver disease. Similarly, we cannot exclude the possibility that some patients with HCV viremia may have tested antibody negative, as previously described in a small proportion of patients with HIV, 22 nor that some antibody-positive patients may have been aviremic. However, a recent study comparing neurocognitive function in patients with HIV with detectable vs undetectable HCV viral loads also showed no difference in neuropathy rates between these groups.…”

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…This should include HCV antibody and HCV RNA PCR when available, as rates of 3–13% of HCV‐seronegative infection have been reported in HIV‐infected adult and paediatric cohorts 133, 134, 135. HCV antigen might be used by some laboratories in screening algorithms.…”