HIV Co-Testing Among Veterans with Chronic Hepatitis C in the Veterans Health Administration

Abstract

Objective: This retrospective study analyzed the testing rates of individuals enrolled in the Hepatitis C Clinical Case Registry for the Veterans Health Administration (VHA) in order to determine Human Immunodeficiency Virus (HIV) co-testing rates for veterans with hepatitis C (HCV). Design: A chart review of 247,006 veterans enrolled in the National HCV Clinical Case Registry was examined retrospectively. Regression analysis identified factors that increased the probability of being tested for HIV. Methods: Simple odds ratios and a complex regression were applied to this dataset to calculate testing incidence and prevalence of HIV. Results: Only approximately one third of veterans with HCV were tested for HIV and, of these, 13.2% were positive. Sixty eight percent of veterans with HCV were not co-tested for HIV and within this group there may be a significant number of unidentified cases of HIV. Veterans with severe mental illness, substance use disorders and marijuana abuse/dependence treatment were more likely to be tested for HIV. Antiviral therapy for HCV had no impact on likelihood of co-testing prior to treatment initiation. Conclusions: Most veterans with HCV are not co-tested for HIV despite common risk factors for HIV and HCV infection. Mandatory testing for HIV, at least among veterans with HCV, as well as identification and removal of barriers to HIV testing within the VHA would serve to facilitate disease management for veterans in the future.

HIV Coinfection With Hepatitis C Virus: Evolving Epidemiology and Treatment Paradigms

“…The VHA has recommended HIV testing for all HCV-infected patients since 2003 [53]. In a retrospective study of veterans with HCV infection who underwent testing for HIV, 13.2% were found to have HIV infection [54]. A missed diagnosis of HIV infection may lead to misinformed treatment decisions and poorer outcomes for both HIV and HCV infections because dual infection alters management of both diseases.…”

Adherence to Screening Guidelines for Hepatitis C Among HIV-Positive Patients

“…8 On the other hand, HIV screening in HCV-positive patients among the Veterans Health Administration, Fuller et al demonstrated that only approximately one-third of veterans with HCV were tested for HIV (32%). 9 The ECDC review on hepatitis B and C collected available data in several specific populations. Among IDUs for example, the proportion of patients screened for HCV varied between 5% in the United Kingdom and 88% in Ireland.…”

A VA Perspective: The Expanding Role of the Clinical Health Psychologist in the New Era of Hepatitis C and Advanced Liver Disease Clinical Care

“…Use of alcohol among co-infected individuals adds an additional risk, with a 2001 meta-analysis indicating that the relative risk of decompensated liver disease or cirrhosis is 2.9 (95% confidence interval, 1.7-5.0) in co-infected individuals compared to individuals with HCV mono-infection [108]. The data demonstrates the need to simultaneously screen for HCV and HIV in order to identify, diagnose, and treat those with co-infections in order to maximize treatment outcomes [115]. The clinical health psychologist situated within infectious disease and liver clinics is in a unique position to inform, refer, and monitor co-infected patients, thus increasing collaboration across clinics and strengthening continuity of care.…”