Examination of Fiscal Management and the Allocation of Care Act Resources US Department of Health and Human Services: Health REsources and Services Administration
INTRODUCTION
HIV/HCV Coinfection
HCV 101
HIV/HCV Coinfection
HCV Diagnostic Testing
Hepatitis A and Hepatitis B Vaccination
Counseling and Support
HCV Treatment
Expanding Access to Treatment
Barriers and Key Issues
Conclusion
Resources
References

HCV Diagnostic Testing

Federal guidelines recommend that all PLWHA be tested for HCV.30,42-45 Antibody testing is not sufficient for diagnosing chronic HCV infection, however, because some people spontaneously clear the virus without treatment but remain antibody positive. A hepatitis C viral load (HCV RNA) test is necessary to confirm or rule out chronic HCV infection (Figure 3). Studies have reported spontaneous viral clearance rates from 15 to 45 percent in HIV-negative persons.7,12-16 Although spontaneous viral clearance is less likely to occur among people who are HIV positive, some PLWHA, particularly those with higher CD4 cell counts, do spontaneously clear HCV infection.46-51

Prior, resolved infection can be distinguished from chronic infection by the presence of HCV antibodies and the absence of detectable HCV RNA (Table 2).

  • HCV RNA is usually detectable within 2 weeks after infection.52
  • HCV antibodies usually develop 6 weeks to 6 months after infection.13 People who have cleared HCV are no longer infected, although antibodies usually remain in the bloodstream for years after spontaneous viral clearance.

All positive HCV antibody results should be confirmed by testing for HCV RNA, but the costs for doing so may be prohibitive in some clinical settings. Thus, to hold down costs, some providers may delay RNA testing until patients are considering treatment or require biopsy. HCV antibodies do not always develop in immunocompromised people, so when HCV infection is suspected or symptoms are present in HCV antibody–negative patients with a CD4 cell count of less than 200/mL, HCV RNA testing should be performed to confirm or rule out chronic HCV infection.53,54

Table 2. Diagnosing Hepatitis C

The CARE Act community is already familiar with the consequences of late diagnosis of HIV disease. Delayed diagnosis of HCV in people who are HIV/HCV coinfected also may have serious consequences. Unfortunately, clinicians are reporting that coinfected patients often are evaluated for HCV treatment after they have developed cirrhosis or end-stage liver disease and may be ineligible for HCV treatment.55-57 Those patients still require care, however, and cirrhotic patients should be screened for varices and hepatocellular cancer.58

 
 
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