Delayed anti-HCV antibody response in HIV-positive men acutely infected with HCV

An epidemic of acute hepatitis C virus (HCV) infection among HIV-positive men who have sex with men is occurring in urban centers in Western Europe and the United States. Early diagnosis and treatment of HCV results in improved sustained virological response rates. This study compared the sensitivity of reverse transcriptase PCR (RT-PCR) versus antibody screening for the diagnosis of early HCV infection in HIV-positive patients and estimated the length of time from HCV infection to the development of anti-HCV antibodies.

Patients from the St Mary's Acute Hepatitis C Cohort (SMACC) were recruited retrospectively and prospectively between 2004 and 2008.

Archived plasma samples, obtained at 1-3 monthly intervals for routine monitoring of HIV viral load were assayed retrospectively for HCV in order to assess the sensitivity of RT-PCR and enzyme-linked immunosorbent assay (ELISA).

: Forty-three HIV-positive patients with early HCV infection were identified. The median CD4 cell count was 570 cells/microl. The median alanine transaminase at the time of the first positive HCV PCR was 65 IU/ml. At this time, 75% of patients had a negative HCV antibody test. Three months later, 37% of patients still had a negative result. After 9 months, 10% of patients had a negative test and 5% remained negative after 1 year.

Delayed seroconversion in HIV-positive individuals with acute HCV may result in delayed diagnosis and treatment. Where there is a clinical suspicion of recent HCV infection, for example, elevated alanine transaminase levels, HIV-infected patients should be screened for HCV RNA by RT-PCR.