The case for better Hepatitis C surveillance in HIV-infected men

Far more needs to be done to diagnose incident Hepatitis C (HCV) in HIV-infected men in the era highly active anti-retroviral therapy (HAART).  This is the message coming out of a recent US long-term study (http://cid.oxfordjournals.org/content/early/2011/01/29/cid.ciq201.full).

Current US Public Health Service HIV guidelines endorse HCV testing only at initial HIV diagnosis – maybe because of low rates of HCV transmission in heterosexual couples.  But, according to the authors of this study, this does not respond to the importance of male to male transmission, and strong possibility, indicated by this study and others, that intravenous drug use is not the dominant means of transmission.  HCV in HIV-infected people is a serious cause of morbidity and mortality, but clinically silent until an advanced stage.  In order to be able to intervene at the acute stage where the disease is responsive to treatment, and to contain epidemiological spread, it is imperative, the authors argue, to develop new approaches to diagnosis and treatment.

Of the 1830 men engaged in the study (94% in HAART) 36 sero-converted, amounting to an incidence of .51 cases in 100 person years.  Sero-conversion was also associated with IDU history (25%) and poor HIV suppression.  This suggests nonparenteral transmission, and possibly a tendency to poor adherence to HAART, suggestive of risk-taking behaviour.

What would be the optimal interval of routine HCV anti-body surveillance for at risk HIV infected persons?  This remains to be determined – but our authors cite the recommendation of the New York State Department of Health AIDS Department, which is for annual serological testing.

Lynn E. Taylor, “Incident Hepatatis C Virus Infection among US HIV Infected men enrolled in Clinical Trials”, Clinical Infectious Diseases, March 2011

http://cid.oxfordjournals.org/content/early/2011/01/29/cid.ciq201.full

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