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One in 5 With HIV in US Never Tested for HCV, Prevalence 21% in Tested
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IDWeek 2014, October 8-12, 2014, Philadelphia
IDSA: Prevalence of and Factors Associated with Hepatitis C Virus Testing and Infection Among HIV-infected Adults Receiving Medical Care in the United States .... 20% Never Tested/21% HCV+/MSM Lo % Tested/Homelessness associated with HCV+ - (10/15/14)
Mark Mascolini
Almost 20% of HIV-positive adults in care in the United States have never been tested for HCV infection, although routine HCV screening is advised for everyone with HIV [1]. Among HIV-positive people tested for HCV in this Centers for Disease Control and Prevention (CDC) analysis, 21% tested positive. Older age, heterosexual orientation, longer time since HIV diagnosis, poverty or homelessness, and other factors were linked to a greater chance of testing HCV-positive.
Understanding HCV testing rates and prevalence in people with HIV has gained urgency with the arrival of highly effective direct-acting antivirals (DAAs) for HCV infection. Research shows DAAs cure HCV infection in people with HIV as often as in HIV-negative populations. If HIV-positive people are coinfected with HCV but do not get tested for the hepatitis virus, they clearly cannot benefit from this striking medical advance.
CDC investigators used 2009 data from the Medical Monitoring Project (MMP) to assess HCV testing rates and prevalence in people with HIV. The MMP is a national surveillance system that uses interviews and medical record abstraction to chart clinical outcomes and behaviors in HIV-positive adults receiving medical care for their infection. The CDC team selected the MMP population to represent the entire HIV-positive population in the United States.
The researchers defined HCV testing as any HCV antibody or RNA test result. They defined HCV infection as any positive HCV antibody or RNA result. They used multivariable logistic regression to generate adjusted prevalence ratios identifying factors associated with HCV testing and HCV prevalence. These analyses accounted for clustering, unequal selection probabilities, and nonresponse.
Analysis of data from 4217 MMP participants determined that an estimated 19% of HIV-positive in care in the United States have never been tested for HCV. Among the 81% tested, an estimated 21% have HCV infection. Five factors were associated with a greater chance of HCV testing at the following adjusted prevalence ratios (aPR) (and 95% confidence intervals):
-- Heterosexual men vs men who have sex with men (MSM): aPR 1.04 (1.00 to 1.09)
-- Black versus white: aPR 1.06 (1.00 to 1.12)
-- Under 10 years since HIV diagnosis vs 10 or more: aPR 1.04 (1.00 to 1.07)
-- AIDS or CD4 nadir 0-199 vs no AIDS + nadir above 500: aPR 1.11 (1.01 to 1.22)
-- No AIDS + CD4 nadir 200-500 vs no AIDS + nadir above 500: aPR 1.14 (1.04 to 1.25)
Eight factors were independently associated with a greater chance of HCV infection at the following aPR (and 95% confidence intervals):
-- 44 or older vs younger: aPR 2.16 (1.73 to 2.71)
-- Heterosexual men vs MSM: aPR 2.01 (1.65 to 2.46)
-- Women vs MSM: aPR 1.50 (1.17 to 1.94)
-- Public vs private insurance: aPR 1.65 (1.29 to 2.10)
-- At or below poverty level: aPR 1.28 (1.11 to 1.48)
-- Homelessness: aPR 1.36 (1.12 to 1.65)
-- 10 or more years since HIV diagnosis vs fewer: aPR 1.49 (1.26 to 1.75)
-- Recent injection drug use: aPR 3.07 (2.52 to 3.74)
Variables not associated with HCV prevalence in this analysis were race, education level, AIDS or nadir CD4 count, and detectable HIV load.
The CDC investigators noted that, despite recent research indicating rising HCV incidence in MSM, they found a lower percentage of MSM getting tested for HCV compared with heterosexual men and with women. The researchers stressed that "all HIV-infected adults, especially those in high-risk groups, should be tested for HCV to increase the number of persons aware of their HCV infection status and eligible for potentially curative treatment."
Reference
1. Garg S, Brooks JT, Luo Q, Skarbinski J. Prevalence of and factors associated with hepatitis C virus testing and infection among HIV-infected adults receiving medical care in the United States. IDWeek 2014. October 8-12, 2014, Philadelphia. Abstract 1588.
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