Factors associated with seronegative chronic hepatitis C virus infection in HIV infection

Clin Infect Dis. 2007 Feb 15;44(4):577-83. doi: 10.1086/511038. Epub 2007 Jan 10.

Abstract

Background: Chronic seronegative hepatitis C virus (HCV) infection is defined as being HCV antibody (anti-HCV) negative, but HCV RNA positivity occurs in individuals infected with human immunodeficiency virus (HIV). However, associated factors are not well established because of the small number of reported cases.

Methods: Multivariate logistic regression analysis of HIV-infected subjects from 4 cohorts (Tien et al., 2006; Bonacini et al., 2001; George et al., 2002; and Hall et al., 2004) determined factors associated with HCV RNA positivity in anti-HCV-negative subjects. HCV enzyme immunoassay 2.0 was used to determine anti-HCV status.

Results: Among 1174 anti-HCV-negative, HIV-infected subjects, the prevalence of seronegative HCV infection was 3.2% (95% confidence interval [CI], 2.2%-4.3%). History of injection drug use (IDU; OR, 5.8; 95% CI, 2.7-12.8), higher alanine aminotransferase (ALT) level (OR, 2.0 per doubling; 95% CI, 1.3-3.2), and CD4 cell count <200 cells/ micro L (OR, 2.3; 95% CI, 1.1-4.8) were associated with HCV RNA positivity in anti-HCV-negative subjects. Among those with a history of IDU who had either a CD4 cell count <200 cells/ micro L or an ALT level greater than the upper limit of normal, the prevalence of seronegative HCV infection was 24% (95% CI, 13%-39%).

Conclusions: Detectable HCV RNA in the context of a negative HCV enzyme immunoassay 2.0 result in HIV-infected patients is low, but higher than the reported prevalence in HIV-uninfected patients. Our findings suggest that HCV RNA testing should be performed in anti-HCV-negative, HIV-infected patients, especially those with a history of IDU and either a CD4 cell count <200 cells/ micro L or an abnormal ALT level.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis*
  • AIDS-Related Opportunistic Infections / epidemiology*
  • Adult
  • Cohort Studies
  • Female
  • Hepatitis C Antibodies / immunology
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / epidemiology*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Predictive Value of Tests
  • RNA, Viral / immunology
  • Radioimmunoassay
  • Risk Factors
  • Seroepidemiologic Studies

Substances

  • Hepatitis C Antibodies
  • RNA, Viral

Grant support