Hepatitis C Screening in People With Human Immunodeficiency Virus: Lessons Learned From Syphilis Screening.

In the era of effective human immunodeficiency virus (HIV) antiretroviral therapy, hepatitis C virus (HCV) has emerged as a major cause of morbidity and mortality in people living with HIV (PLWH) [1–7]. With the recent advent of more efficacious and tolerable HCV medications, many people with HIV and HCV coinfection are now receiving HCV treatment and being cured. The first step in the cascade of HCV care is aggressive identification of persons with infection. Identification of HCV is important not only for the patient's health, but from a public health perspective early diagnosis and referral into HCV treatment is one method of reducing the amount of circulating virus and preventing new infections. In the first 2 decades of the HIV epidemic, the most common route of exposure to HCV was injection drug use (IDU), which commonly preceded HIV infection [8–10]. Hepatitis C virus screening with HCV antibody (Ab) was recommended upon HIV diagnosis, in the setting of abnormal liver enzymes, or with the report of new high-risk behaviors [11]. However, data published in 2005 from Swiss HIV Cohort Study reported an increase in incident HCV cases in HIV-positive men who have sex with men (MSM) [12]. The shift in epidemiology has subsequently been confirmed in numerous international locations and attributed to increasingly risky sexual and drug-use patterns within the MSM population [13–17]. As a result, several professional societies have recommended switching from symptom and risk-based guided HCVAb screening to annual screening of HIV-positive patients for HCV infection [18–20]. Despite these updated guidelines, HIV clinicians are not testing previously HCVAb-negative PLWH annually for incident HCV infection [21–26]. The reasons for low annual screening rates are likely multifactorial, but they may include lack of knowledge of the changing epidemic, underappreciation of risk for sexual transmission of HCV, slow dissemination of the updated guidelines into practice, and continued risk-based screening practices. The relative contributions of each of these factors are unknown. One way to further investigate whether clinicians are relying on risk-based screening methods and whether they are correctly assessing risk for sexual HCV transmission is to compare annual HCV screening to annual screening for syphilis. For over 10 years, annual syphilis testing has been recommended for all sexually active HIV patients, and physician compliance with annual screening for syphilis is a national HIV quality-of-care benchmark [27, 28]. This study examines the frequency of HCVAb screening and syphilis and compares this across different risk groups using multivariate analysis to identify demographic and clinical characteristics associated with repeat testing. Persons with incident HCV infection, identified during the course of the study, are described.