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National multicenter study of HIV testing and HIV seropositivity in patients with chronic hepatitis C virus infection
Edmund J Bini1, Sue L Currie, Hui Shen
1VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY, USA. Edmund.Bini@med.va.gov
Insights
Many patients with hepatitis C virus (HCV) infection are tested for human immunodeficiency virus (HIV), but opportunities for early diagnosis are missed. Improved public health strategies are needed to increase HIV testing in this population.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Hepatitis C virus (HCV) infection is common, and coinfection with human immunodeficiency virus (HIV) presents unique challenges.
- HIV testing is recommended for at-risk HCV-infected individuals, yet data on testing prevalence and associated factors are limited.
Purpose of the Study:
- To assess the prevalence of HIV testing among HCV-infected patients.
- To identify factors associated with HIV testing and seropositivity in this population.
- To highlight missed opportunities for early HIV diagnosis.
Main Methods:
- Prospective data collection from 4364 HCV-infected patients across 24 US Veterans Affairs medical centers.
- Inclusion of demographics, HIV risk factors, and self-reported HIV testing history.
- Multivariable analysis to identify independent predictors of HIV testing and seropositivity.
Main Results:
- 76.8% of HCV patients reported at least one HIV test; 14.8% were never tested.
- Risk factors for HIV testing included injection drug use, needlestick injury, same-sex partnerships, and higher numbers of lifetime sexual partners.
- HIV risk factors were present in 84.5% of never-tested individuals.
- Among tested patients, 8.4% were HIV positive; African American/Hispanic race, low income, same-sex partnerships, and sex with an injection drug user were associated with seropositivity.
Conclusions:
- A significant proportion of HCV-infected patients undergo HIV testing, but opportunities for early diagnosis remain.
- Public health interventions are necessary to enhance HIV testing rates among individuals with chronic HCV infection.
- Targeted strategies are needed to address disparities and improve testing uptake in high-risk subgroups.
Background:
Although HIV testing is recommended for persons with hepatitis C virus (HCV) infection who are at risk for HIV, little is known about HIV testing in this population.
Methods:
Data were prospectively collected in 4364 HCV-infected patients at 24 Veterans Affairs medical centers across the United States, including demographics, risk factors for HIV infection, and self-reported information on HIV testing.
Results:
Overall, 76.8% had been tested for HIV at least once, 14.8% were never tested, 6.6% did not know if they were tested, and 1.8% declined to answer. Multivariable analysis identified injection drug use, needlestick injury, sex with a same-sex partner, a greater number of lifetime sexual partners, and sex with an injection drug user as factors that were independently associated with HIV testing. At least one risk factor for HIV infection was present in 84.5% of the 646 patients who were never HIV tested. Among the 3350 subjects who were tested for HIV, 8.4% were positive, 88.3% were negative, 2.4% did not know the results of their test, and 0.9% declined to answer. Multivariable analysis identified African American and Hispanic race/ethnicity, income < or = 10,000 dollars, sex with a same-sex partner, and sex with an injection drug user as the only variables that were independently associated with HIV seropositivity.
Conclusions:
Although a substantial proportion of HCV-infected patients have been tested for HIV, missed opportunities for early diagnosis of HIV infection exist. Public health strategies to improve HIV testing among patients with chronic HCV infection are needed.
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