Figure two represents a flow chart for a diagnostic algorithm for HCV
testing HIV-Positive Patients. At the top of the flow chart is HCV
antibody testing - which the federal guidelines recommend that all
HIV-positive individuals be tested for HCV antibodies. The chart then
breaks off into two strains based on the outcome of the HCV test
results, which is depicted by an arrow pointing down from HCV Antibody
testing to the next level.

We will first describe the flow of the chart on the left which speaks to
those who have positive HCV antibody test results. If they are positive,
the patient should be provided with HCV RNA (viral load) testing.
Another arrow flows from this to HCV RNA Testing, which then has two
arrows flowing from it - showing two more categories. On the right is
what the patient should do if RNA is detectable. If it is dectable, the
patient has chronic HCV infection and should receive comprehensive HCV
care services that include vaccinations for hapatitis A and B;
counseling, with an alcohol and drug use component; treatment education;
and, when appropriate, HCV treatment. On the left is what the patient
should do if RNA is undetectable. If undetectable, patients should have
the test repeated in six months to confirm or rule out chronic HCV
infection. Patients should be provided prevention counseling and
education and vaccinations for both hepatitis A and hepatitis B.

On the right, the chart delineates what should happen if the HCV
antibody test results are negative. If negative, those with no known
risk or possible exposure to HCV should receive HCV prevention
counseling. Under this a BUT which notes that HCV RNA (viral load)
testing should be considered for (and lists through bullet points the
following): 1. PLWHA with CD4 cell count of more then 200 over mL;
2. people with recent exposure to HCV, acute hepatitis,
elevated liver enzymes, or other signs of hepatitis; and
3. active injection drug users.

An arrow points to the left of this notation and connects to HCV RNA
Testing and follows the same flow as mentioned earlier.