title: Clinical variables identify seronegative HCV co-infection in HIV-infected individuals.
abstract: BACKGROUND
  A substantial number of people living with HIV (PLWH) are co-infected with Hepatitis C Virus (HCV) but have a negative screening HCV antibody test (seronegative HCV infection, or SN-HCV).
  
  
  OBJECTIVE
  To identify a concise set of clinical variables that could be used to improve case finding for SN-HCV co-infection among PLWH.
  
  
  METHODS
  Two hundred HIV-infected participants of the CHARTER study were selected based on 7 clinical variables associated with HCV infection but were HCV seronegative. Data were analyzed using Fisher's exact tests, receiver-operating characteristic (ROC) curves, and logistic regression.
  
  
  RESULTS
  Twenty-six (13%) participants had detectable HCV RNA. SN-HCV was associated with a history of IDU, elevated ALT and AST, low platelets, black ethnicity, and undetectable HIV RNA in plasma. Each of these clinical variables, except for abnormal AST, remained independently associated with SN-HCV in a multivariate logistic regression analysis. A composite risk score correctly identified SN-HCV with sensitivity up to 85% and specificity up to 88%.
  
  
  CONCLUSIONS
  In a substantial minority of PLWH, seronegative HCV viremia can be predicted by a small number of clinical variables. These findings, after validation in an unselected cohort, could help focus screening in those at highest risk.
authors.affiliation: University of California, San Diego, La Jolla, CA 92093, USA. abharti@ucsd.edu
authors.forename: Ajay R
authors.initials: AR
authors.lastname: Bharti
authors.forename: Scott L
authors.initials: SL
authors.lastname: Letendre
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.forename: David
authors.initials: D
authors.lastname: Clifford
authors.forename: Ann C
authors.initials: AC
authors.lastname: Collier
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gelman
authors.forename: Justin
authors.initials: J
authors.lastname: McArthur
authors.forename: Christina
authors.initials: C
authors.lastname: Marra
authors.forename: Allen
authors.initials: A
authors.lastname: McCutchan
authors.forename: Susan
authors.initials: S
authors.lastname: Morgello
authors.forename: David
authors.initials: D
authors.lastname: Simpson
authors.forename: Ron J
authors.initials: RJ
authors.lastname: Ellis
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers; D044383:Black People; D060085:Coinfection / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications; D013921:Thrombocytopenia / Q000150:complications
chemical_list: D015415:Biomarkers; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase