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24% with HCV Are HIV+ at NYC Hospitals Studied
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"HIV TESTING AND HIV SEROPOSITIVITY AMONG PATIENTS WITH CHRONIC HCV: MISSED OPPORTUNITIES FOR EARLY DIAGNOSIS"
Reported by Jules Levin
http://www.natap.org
from AASLD
Nov 11, 2005, San Francisco
Gerald Villanueva, Bellevue Hospital and NYU School of Medicine, New York, NY; Nilesh Shukla, NYU School of Medicine, New York, NY; Craig T. Tenner, VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY; Ayse Aytaman, VA New York Harbor Healthcare System, Brooklyn, NY; Edmund J. Bini, VA New York Harbor Healthcare System and NYU School of
Medicine, New York, NY
Background: Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) is a major public health problem worldwide. The 2002 National Institutes of Health HCV Consensus Conference recommended that patients with HCV infection who are at risk for HIV should be offered HIV testing. To date, however, little is known about HIV testing in this population. The
aims of this study were to determine the proportion of patients with chronic HCV infection who were tested for HIV and to evaluate the frequency of HIV seropositivity in this population.
Methods: 569 patients with chronic HCV infection and 670 HCV antibody negative controls completed a survey at the time of their outpatient clinic visit at 3 study sites. Data collected included patient demographics, risk factors for HCV and HIV infection, and information regarding prior HIV testing.
Results:
Overall, the mean age of the 1,239 patients was 55.2 ± 10.3 years, 80.8% were men, and the population was ethnically diverse with 36.5% non-Hispanic whites, 37.4% non-Hispanic blacks, 19.6% Hispanics, and 6.5% who reported their ethnicity as "other".
Of the 569 HCV(+) patients, 62.6% were tested for HIV, 35.7% were never tested, and 1.8% did not know if they were tested and this differed significantly (p <0.001) from HCV(-) patients (43.9%, 49.4%, and 6.7%, respectively).
Among HCV(+) patients, the proportion tested for HIV decreased with age (p <0.001), was more common in men than in women (70.0% vs. 38.4%, p 0.001), and differed according to ethnicity (p=0.001).
Importantly, risk factors for HIV infection were common among the 203 HCV(+)
patients who were never HIV tested, including:
-- injection drug use (68.0%),
-- >/=10 lifetime sexual partners (58.1%),
-- sex with a prostitute (58.1%), and
-- sex with a same-sex partner (13.3%).
Of the HCV(+) patients who were tested for HIV, 23.9% were positive, 74.2% were negative, and 2.0% did not know the results of their HIV test; this
differed significantly (p=0.04) from HCV(-) patients (16.0%, 81.3%, and 2.7%, respectively). Among HCV(+) patients, the proportion that tested positive for HIV did not differ according to age (p=0.27), but was higher in women than in men (41.9% vs. 21.9%, p=0.004) and differed according to ethnicity (p 0.049).
Conclusions: Although HCV(+) patients were more likely to be tested for HIV than HCV(-) subjects, missed opportunities for early diagnosis of HIV infection exist. The high prevalence of HIV seropositivity and risk factors for HIV infection in patients with HCV suggests that the current testing guidelines should be revised
to recommend universal HIV testing for all HCV-infected persons.
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