title: Current practices of screening for incident hepatitis C virus (HCV) infection among HIV-infected, HCV-uninfected individuals in primary care.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center.
authors.forename: J Morgan
authors.initials: JM
authors.lastname: Freiman
authors.affiliation: HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center.
authors.forename: Wei
authors.initials: W
authors.lastname: Huang
authors.affiliation: Departments of Biostatistics.
authors.forename: Laura F
authors.initials: LF
authors.lastname: White
authors.affiliation: School of Medicine, University of California, San Francisco.
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Geng
authors.affiliation: Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Hurt
authors.affiliation: Department of Medicine, Brown University, Providence, Rhode Island.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Taylor
authors.affiliation: Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine.
authors.forename: E Turner
authors.initials: ET
authors.lastname: Overton
authors.affiliation: Department of Medicine, University of California, San Diego.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Cachay
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Benigno
authors.initials: B
authors.lastname: Rodriguez
authors.affiliation: Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center Epidemiology, Boston University School of Public Health, Massachusetts.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Linas
mesh_terms: D000328:Adult; D060085:Coinfection / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D015658:HIV Infections / Q000097:blood*; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies
keywords: HIV; hepatitis C; incidence; men who have sex with men; screening