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Factors associated with seronegative chronic hepatitis C virus infection in HIV-infection
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...IDU and CD4 <200 associated with HCV PCR being positive when HCV antibody negative...
Reported by Jules Levin
XVI IAC Aug 2006 Toronto
Background: Seronegative chronic hepatitis C virus (HCV) infection, defined as being HCV antibody negative (anti-HCV-) but HCV RNA+, occurs in HIV+ patients, but the associated factors are not well established.
Methods: Factors associated with being HCV RNA+ in anti-HCV- subjects, and factors associated with being anti-HCV- in HCV RNA+ subjects, were analyzed by multivariate logistic regression in HIV+ using pooled data from the study of Fat Redistribution and Metabolic Changes in HIV infection (FRAM) and three published studies (Bonacini et al, 2001, George et al, 2002, and Hall et al, 2004). HCV enzyme immunoassay (EIA 2.0) determined anti-HCV status.
Results:
869 of 1151 FRAM subjects were anti-HCV-; 15 HCV RNA+. The pooled prevalence of seronegative HCV infection was 2.0% (37 of 1856); in anti-HCV- subjects, 3.1% (37 of 1175).
History of injection drug use (IDU) (OR = 6.22; 95% CI: 2.61-14.78), higher ALT (OR = 1.99 per doubling; 95% CI: 1.24-3.19), and current CD4 <200 (OR=2.31; 95% CI: 1.02-5.21) were associated with detectable HCV RNA in anti-HCV- subjects.
Among HIV+ with detectable HCV RNA, a history of IDU (OR = 0.26; 95% CI: 0.13-0.56) and older age (OR = 0.43 per decade; 95% CI: 0.27-0.69) were associated with decreased risk of being anti-HCV-; current CD4 <200 (OR = 2.80; 95% CI: 1.36-5.77) was associated with increased risk.
Conclusions:
Anti-HCV- HIV+ individuals with elevated ALT should undergo HCV RNA testing, especially those with CD4 <200 and history of IDU (as expected because IDU is a risk factor for HCV). Analysis of HIV+ subjects with detectable HCV RNA suggests that patients with CD4 <200 and younger patients, and those without a history of IDU are more likely to be anti-HCV-. Investigation of how immunosuppression and viral factors impact serologic detection of HCV in specific populations is therefore needed.
Chamie G.1, Bonacini M.2, Bangsberg D.1, Hall C.3, Stapleton J.4, Overton E.T.5, Scherzer R.6, Tien P.C.7
1University of California, San Francisco, Medicine, San Francisco, United States, 2California Pacific Medical Center, Medicine, San Francisco, United States, 3California Department of Health Services, Sexually Transmitted Disease Control Branch, Oakland, United States, 4University of Iowa, Medicine, Iowa City, United States, 5Washington University, St. Louis, Medicine, St. Louis, United States, 6Department of Veterans Affairs, Metabolism Section, San Francisco, United States, 7University of California, San Francisco and Department of Veterans Affairs, Medicine, San Francisco, United States
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