Researchers from Boston Medical Center have found that although most patients with HIV were screened for hepatitis C virus infection when enrolling into care, only half of those who were uninfected at baseline were screened again during their care.
“Understanding current practices, as well as the rate of uptake of more routine screening for incident HCV infection, is essential to inform the development of evidence-based HCV screening strategies,” the researchers wrote in Clinical Infectious Diseases.
The researchers used data from CFAR Network of Integrated Clinical Systems (CNICS) to conduct a retrospective cohort study to evaluate HCV testing among patients with HIV. Among the 17,090 CNICS participants seen at least once from 2000 to 2011, 93.6% were screened for HCV antibodies at least once during their care, and 85% of those were screened within 3 months of the first clinic visit. Among those, 9,077 patients with a nonreactive HCV antibody test at baseline were included in the analysis.
Among the 9,077 patients, 55.6% had at least one surveillance HCV antibody or RNA test during their care. In a multivariate analysis, participants who inconsistently used condoms during anal sex were more likely to receive HCV screening (OR=1.31; 95% CI, 1.08-1.59). Participants who reported amphetamine use were also more likely to be screened (OR=1.86; 95% CI, 1.42-2.44). A history of AIDS-defining illness and a history of non-HCV liver disease also were associated with greater odds of HCV surveillance.
In addition, the clinical site was a predictor of receiving surveillance HCV screening, with the rate of screening varying significantly between sites. HCV screening rates increased over time, but not equally at all sites.
Among the 5,042 participants with at least one surveillance test, 267 seroconverted, and the mean serum alanine aminotransferase level before a positive HCV test was 101.7 (95% CI, 82.8-120.8). Among patients with first-time alanine aminotransferase levels of more than 100 IU/L, only 26.7% were followed up with an HCV antibody or RNA test.
“Screening for incident HCV is variable across sites and improvement in frequency of screening is also variable, highlighting a need for US-based guidelines to inform HIV practice,” the researchers wrote. “While publishing a recommendation for frequent and routine HCV screening will not itself change clinical practice, doing so would encourage providers to screen routinely and provide a metric by which practices could measure their performance.”
Disclosure: One researcher has a financial relationship with Gilead Sciences.