1From the HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center.
2Department of Biostatistics.
3Boston University School of Public Health; the University of California, San Francisco.
4Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill.
5Department of Medicine, Brown University.
6University of Alabama at Birmingham School of Medicine.
7University of California, San Diego.
8Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington.
9Division of Infectious Diseases, Johns Hopkins University.
10Division of Infectious Diseases & HIV Medicine, Case Western Reserve University.
11The Fenway Institute, Fenway Health, Boston, Massachusetts.
12From the HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center Department of Epidemiology.
HIV-infected, HCV-uninfected patients are at risk for incident HCV infection, but little is known about screening practices for incident HCV among HIV-infected individuals in HIV primary care clinics.
We used data from the CFAR Network of Integrated Clinical Systems (CNICS) to investigate historical trends in screening for incident HCV infection among HIV-infected patients who were HCV-uninfected at enrollment in care. We used descriptive measures and Poisson regression to identify factors associated with screening for HCV infection (using HCV antibody or RNA), performed temporal analyses to assess changes in screening over time, and investigated the frequency with which elevated alanine aminotransferase (ALT) levels were followed by diagnostic HCV testing.
Among 17,090 patients registered at CNICS sites between 2000-2011, 14,534 (85%) received HCV Ab screening within 3-months of enrolling in care, and 9,077 met all of the inclusion criteria. Only 55.6% ever received additional HCV screening following. HCV screening increased over time, but not uniformly at all sites. Only 26.7% of first-time ALT elevations to >100 IU/L were followed-up within 12 months by HCV Ab or RNA testing.
Though most HIV-infected patients were screened for prevalent HCV infection at enrollment in care, only half who were HCV-uninfected were screened again. Screening varied between sites, even when controlling for demographics and risk behaviors. Patients with new ALT elevations to >100 IU/L were seldom assessed for incident HCV infection. Guidelines are needed to help HIV providers know who to screen, how frequently to screen, and which screening test to use.