Freiman J Morgan, Huang Wei, White Laura F, Geng Elvin H, Hurt Christopher B, Taylor Lynn E, Overton E Turner, Cachay Edward R, Kitahata Mari M, Moore Richard D, Rodriguez Benigno, Mayer Kenneth H, Linas Benjamin P
HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center.
Departments of Biostatistics.
Clin Infect Dis. 2014 Dec 15;59(12):1686-93. doi: 10.1093/cid/ciu698. Epub 2014 Sep 3.
Human immunodeficiency virus (HIV)-infected, hepatitis C virus (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 Center for AIDS Research 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 and 2011, 14 534 (85%) received HCV antibody screening within 3 months of enrolling in care, and 9077 met all of the inclusion criteria. Only 55.6% ever received additional HCV screening. 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 antibody or RNA testing.
Although 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 whom to screen, how frequently to screen, and which screening test to use.
感染人类免疫缺陷病毒（HIV）但未感染丙型肝炎病毒（HCV）的患者有感染HCV的风险，但对于HIV初级保健诊所中HIV感染者发生HCV感染的筛查实践知之甚少。
我们使用综合临床系统艾滋病研究网络中心（CNICS）的数据，调查在入组时未感染HCV的HIV感染者中HCV感染筛查的历史趋势。我们使用描述性指标和泊松回归来确定与HCV感染筛查（使用HCV抗体或RNA）相关的因素，进行时间分析以评估筛查随时间的变化，并调查丙氨酸氨基转移酶（ALT）水平升高后进行HCV诊断检测的频率。
在2000年至2011年期间在CNICS站点登记的17090名患者中，14534名（85%）在入组护理后3个月内接受了HCV抗体筛查，9077名符合所有纳入标准。只有55.6%的人曾接受过额外的HCV筛查。HCV筛查随时间增加，但并非在所有站点都均匀增加。首次ALT升高至>100 IU/L的患者中，只有26.7%在12个月内接受了HCV抗体或RNA检测。
虽然大多数HIV感染者在入组护理时接受了HCV感染的筛查，但未感染HCV的患者中只有一半再次接受了筛查。即使在控制人口统计学和风险行为的情况下，各站点之间的筛查情况也有所不同。ALT新升高至>100 IU/L的患者很少接受HCV感染的评估。需要指南来帮助HIV提供者了解筛查对象、筛查频率以及使用哪种筛查检测方法。
