Viral RNA Testing in Hepatitis C Antibody–Positive Veterans

Rongey, Catherine; Kanwal, Fasiha; Hoang, Tuyen; Gifford, Allen L.; Asch, Steven M.

doi:10.1016/j.amepre.2008.10.013

Cited by 29 publications

(20 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The observation that patients with a history of elevated ALT levels have greater odds of receiving HCV RNA testing supports results from earlier studies, 22,24 and may be indicative of healthcare provider knowledge of the high correlation between persistently elevated ALT levels and the probability of liver disease. 17,30–32 The association between black race and lower odds of receiving HCV RNA testing may be confounded by lower levels of healthcare access among blacks 33,34 and should be interpreted with caution, in part owing to the inability to adjust for socioeconomic measures (e.g., insurance type).…”

Section: Discussionsupporting

confidence: 82%

HIV Infection Status as a Predictor of Hepatitis C Virus RNA Testing in Primary Care

Yartel

Rein

Brown

et al. 2015

American Journal of Preventive Medicine

View full text Add to dashboard Cite

Introduction Receipt of hepatitis C virus (HCV) RNA testing following a positive HCV antibody (anti-HCV+) test result to establish current infection is a quality indicator for HCV-related care. This study examines HIV infection status as a predictor of HCV RNA test receipt after an anti-HCV+ result in the primary care setting. Methods Electronic medical records of anti-HCV+ patients from a multisite retrospective study of patients aged ≥18 years who utilized one or more primary care outpatient services during 2005–2010 were analyzed in 2014. A multivariable logistic regression model examined the independent relationships between patient characteristics and receipt of HCV RNA testing. Results Among 1,115 anti-HCV+ patients, 133 (11.9%) were also HIV-positive. Of these, 77.4% (n=103) underwent HCV RNA testing to determine current infection status. By contrast, 66.7% (n=654/980) of anti-HCV+ patients who were HIV-negative received HCV RNA testing. Following multivariable adjustment, the odds of receiving HCV RNA testing were higher among anti-HCV+ patients who were also HIV-positive (AOR=1.9, 95% CI=1.2, 3.0), compared with their HIV-negative counterparts. Elevated alanine aminotransferase level was also associated with receipt of HCV RNA testing (AOR=1.9, 95% CI=1.4, 2.4). Black race was associated with decreased odds of receiving HCV RNA testing (AOR=0.7, 95% CI=0.5, 1.0). Conclusions HIV infection status is independently associated with the likelihood of receiving HCV RNA testing following an anti-HCV+ result. One quarter of anti-HCV+ patients who were also HIV-positive and one third of their HIV-negative counterparts, respectively, did not receive testing to establish active HCV infection, which is imperative for appropriate care and treatment.

show abstract

Section: Discussionsupporting

confidence: 82%

HIV Infection Status as a Predictor of Hepatitis C Virus RNA Testing in Primary Care

Yartel

Rein

Brown

et al. 2015

American Journal of Preventive Medicine

View full text Add to dashboard Cite

show abstract

“…In LMICs where implementation of a complex algorithm is often not feasible and diagnostic capacity is low, less than 1% of patients are aware of their infection (6). Additionally, a significant proportion of HCVAb positive patients fail to have a diagnostic NAT and are lost to follow-up (7). The two-step diagnostic process represents a major bottleneck to the HCV cascade of care that needs to be addressed in order to achieve the ambitious elimination strategy proposed by the World Health Organization (WHO)(8).…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C Core Antigen Testing for Diagnosis of Hepatitis C Virus Infection

Freiman¹,

Tran²,

Schumacher³

et al. 2016

Ann Intern Med

156

148

View full text Add to dashboard Cite

Background Diagnosis of chronic Hepatitis C Virus (HCV) infection requires both a positive HCV antibody screen and confirmatory nucleic acid test (NAT). HCV core antigen (HCVcAg) is a potential alternative to NAT. Purpose This systematic review evaluated the accuracy of diagnosis of active HCV infection among adults and children for five HCVcAg tests compared to NAT. Data Sources EMBASE, PubMed, Web of Science, Scopus, and Cochrane from 1990 through March 31, 2016. Study Selection Cohort, cross-sectional, and randomized controlled trials were included without language restriction Data Extraction Two independent reviewers extracted data and assessed quality using an adapted Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data Synthesis 44 studies evaluated 5 index tests. Studies for the ARCHITECT had the highest quality, while those for Ortho ELISA were the lowest. From bivariate analyses, the sensitivity and specificity with 95% CI were: ARCHITECT 93.4% (90.1, 96.4) and 98.8% (97.4, 99.5), Ortho ELISA 93.2% (81.6, 97.7) and 99.2% (87.9, 100), and Hunan Jynda 59.5% (46.0, 71.7) and 82.9% (58.6, 94.3). Insufficient data were available for a meta-analysis for Lumipulse and Lumispot. In three quantitative studies using ARCHITECT, HCVcAg correlated closely with HCV RNA above 3000 IU/mL. Limitations There was insufficient data on covariates such as HIV or HBV status for sub-group analyses. Few studies reported genotypes of isolates and there were scant data for genotypes 4, 5, and 6. Most studies were conducted in high resource settings within reference laboratories. Conclusions HCVcAg assays with signal amplification have high sensitivity, high specificity, and good correlation with HCV RNA above 3000 IU/mL. HCVcAg assays have the potential to replace NAT in high HCV prevalence settings.

show abstract

“…11 Several studies of patients seen in health systems across the US have found that not all patients receive recommended HCV RNA testing after a positive antibody. 12,13 Some clinicians may be unaware of the current widespread availability of HCV RNA tests and recommendations for determining viral status for patients who screen positive for HCV antibodies. 14 Also, because HCV RNA tests are expensive, confirmatory testing may not be ordered for patients who are HCV antibody positive but lack insurance coverage.…”

mentioning

confidence: 98%