Department of Medicine, Division of Infectious Disease, Brown University, Providence, Rhode Island 02906, USA.
AIDS Patient Care STDS. 2011 Oct;25(10):571-7. doi: 10.1089/apc.2011.0106. Epub 2011 Aug 22.
Acute hepatitis C virus (HCV) infection is being acquired undetected among HIV-infected individuals. A practical way to regularly screen HIV-infected patients for acute HCV irrespective of perceived risk or symptoms is needed. We piloted implementation of an acute HCV screening strategy using routine HIV clinical care schedules and the least costly blood tests, in a Rhode Island HIV care center. Study participants had ongoing HCV risk, completed questionnaires encompassing risk behaviors and perception of risk, and were screened with quarterly alanine aminotransferase (ALT). ALT rise triggered HCV RNA testing, with pooled rather than individual specimen HCV RNA testing for underinsured participants. Participants were primarily older, college-educated men who have sex with men (MSM) with history of sexually transmitted infection other than HIV. One of 58 participants developed acute HCV in 50 person-years of observation for an annual incidence of 2.0% per year (95% confidence interval [CI] 0.05-11.1%). The majority (54%) of MSM did not perceive that traumatic sexual and drug practices they were engaging in put them at risk for HCV. Unprotected sex often occurred under the influence of drugs or alcohol. Self-reported HCV risk and participation in several risk behaviors declined during the study. It was possible to collect frequent ALTs in a busy HIV clinic with 71% of total projected ALTs obtained and 88% of participants having at least one ALT during the 9-month follow-up period. All instances of ALT rise led to reflexive HCV RNA testing. Tracking quarterly ALT for elevation to systematically prompt HCV RNA testing before seroconversion is a promising approach to screen for acute HCV in a real-world HIV clinical setting.
急性丙型肝炎病毒 (HCV) 感染在 HIV 感染者中未被察觉地发生。需要有一种实用的方法，能够定期对 HIV 感染者进行急性 HCV 筛查，无论其感知到的风险或症状如何。我们在罗德岛的一家艾滋病毒护理中心，试用了一种使用常规艾滋病毒临床护理时间表和最廉价的血液检测来筛查急性 HCV 的策略。研究参与者具有持续的 HCV 风险，完成了包含风险行为和风险感知的问卷，并每季度进行丙氨酸氨基转移酶 (ALT) 筛查。ALT 升高触发 HCV RNA 检测，对于未参保者，采用混合而非单独标本 HCV RNA 检测。参与者主要是年长、受过大学教育的男男性行为者 (MSM)，他们除 HIV 外还有其他性传播感染史。在 50 人年的观察中，有 58 名参与者中的 1 人发生急性 HCV，年发病率为每年 2.0%（95%置信区间 [CI] 0.05-11.1%）。大多数 (54%) MSM 认为他们正在进行的创伤性性和药物行为不会使他们面临 HCV 风险。无保护的性行为经常在药物或酒精的影响下发生。在研究期间，自我报告的 HCV 风险和参与多种风险行为有所减少。在一家繁忙的 HIV 诊所中，可以定期采集 ALT，共获得了预计 ALT 的 71%，88%的参与者在 9 个月的随访期间至少有一次 ALT。所有 ALT 升高的情况均导致 HCV RNA 检测的反射性检测。通过定期监测 ALT 升高来系统地提示 HCV RNA 检测，以在血清转换前筛查急性 HCV，这是在真实世界的 HIV 临床环境中筛查急性 HCV 的一种很有前途的方法。
