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. 2011 Dec;52(4):328-32.
doi: 10.1016/j.jcv.2011.08.021. Epub 2011 Sep 15.

Clinical variables identify seronegative HCV co-infection in HIV-infected individuals

Ajay R Bharti  1 , Scott L Letendre, Tanya Wolfson, David Clifford, Ann C Collier, Benjamin Gelman, Justin McArthur, Christina Marra, Allen McCutchan, Susan Morgello, David Simpson, Ron J Ellis, Igor Grant
Affiliations

Clinical variables identify seronegative HCV co-infection in HIV-infected individuals

Ajay R Bharti et al. J Clin Virol. 2011 Dec.

Abstract

Background: A substantial number of people living with HIV (PLWH) are co-infected with Hepatitis C Virus (HCV) but have a negative screening HCV antibody test (seronegative HCV infection, or SN-HCV).

Objective: To identify a concise set of clinical variables that could be used to improve case finding for SN-HCV co-infection among PLWH.

Study design: Two hundred HIV-infected participants of the CHARTER study were selected based on 7 clinical variables associated with HCV infection but were HCV seronegative. Data were analyzed using Fisher's exact tests, receiver-operating characteristic (ROC) curves, and logistic regression.

Results: Twenty-six (13%) participants had detectable HCV RNA. SN-HCV was associated with a history of IDU, elevated ALT and AST, low platelets, black ethnicity, and undetectable HIV RNA in plasma. Each of these clinical variables, except for abnormal AST, remained independently associated with SN-HCV in a multivariate logistic regression analysis. A composite risk score correctly identified SN-HCV with sensitivity up to 85% and specificity up to 88%.

Conclusions: In a substantial minority of PLWH, seronegative HCV viremia can be predicted by a small number of clinical variables. These findings, after validation in an unselected cohort, could help focus screening in those at highest risk.

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Figures

Figure 1
Figure 1
Distribution of HCV RNA among individuals with seronegative HCV.
Figure 2
Figure 2
Receiver-operating characteristic curve comparing summed clinical variables to occurrence of SN-HCV.
Figure 3
Figure 3
Relationship of SN-HCV to site and number of clinical variables. The utility of clinical variable numbers in distinguishing SN-HCV depends in part on the underlying population prevalence. Thus, at a site with low prevalence (“A”), the actual likelihood of SN-HCV remains relatively low even when multiple clinical variables (up to 4) are present. By contrast, at a site with high overall prevalence (“B”), the likelihood of SN-HCV increases steeply with each additional clinical variable.
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