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SCREENING TESTS : All HIV-infected patients should be screened with HBsAg, anti-HBs and anti-HBc. Note that routine testing for HBcAb may be unnecessary.
BASELINE EVALUATION (See pg __)
- Anti-HBs and HBsAg negative: vaccinate
- HBsAg positive: evaluate for chronic infection with HBeAg, HBV DNA, liver function tests
- Anti-HBc positive, anti-HBs/HBsAg-negative: rule out chronic HBV infection with HBV DNA, vaccinate if negative
HCV (MMWR 2004;53,[RR-15]:1; 2008 DHHS OI Guidelines): The seroprevalence of HCV is 1.8% in the general population, 4%-6% in MSM, and 70%-90% in IDUs and hemophilia patients.
SCREENING : All HIV-infected persons should be tested for HCV infection using the sensitive third-generation EIA screening assay for anti- HCV antibodies Hepatology 2002;36;S3. The third-generation EIAs have a sensitivity and specificity of >99% in immunocompetent patients, but there may be false-negatives with severe immuno - suppression (e.g. CD4 counts <100 cells/mm3)(JAIDS 2002;31:154) and some with acute HCV infections. Qualitative or quantitative HCV RNA assays should be ordered in patients with suspected false-negative results (J Infect Dis 1994;170:433; Blood 1993;82:1010).
CONFIRMATORY TEST : For patients with a positive EIA screening test, qualitative HCV RNA assay is recommended for confirmation, although it is generally unnecessary in patients with risk factors for HCV infection and an abnormal ALT. Qualitative HCV RNA assays have a threshold of detection of 50-100 IU/mL. A negative test does not exclude HCV, because HCV RNA levels may periodically decline below limits of detection; repeat testing is required to rule out chronic HCV infection.
EVALUATION : 1) Quantitative HCV assay, 2) liver function tests and 3) HCV genotype. Quantitative HCV assays (bDNA or RNA PCR) are viral load assays that have a threshold of detection of 500 IU/ mL and may be used in place of the qualitative RNA test to establish the diagnosis since this test will be necessary for clinical management anyway.The HCV RNA viral load does not correlate with disease severity or rate of progression; it does correlate with response to therapy.Their principal use is to monitor response to therapy. Hepatic transaminases should be measured in patients with chronic HCV infection, although there may be significant liver disease with persistently normal AST and ALT levels. An HCV genotype should be measured, since the genotype is an important predictor of response to therapy.Genotype 1 accounts for about 75% and shows relatively poor response to interferon
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