Molecular epidemiology and management of acute HCV infection in HIV co-infected patients
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
31
Journal Issue
5
Pages
308-312
Date Issued
2020
Author(s)
Abstract
Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the similar bloodborne transmission route. While the majority of patients coinfected with HIV and HCV are injecting drug users (IDUs), the epidemic of sexually transmitted HCV infection has emerged mainly among men who have sex with men (MSM). Sexually transmitted HCV infection has been linked to high-risk sexual behaviors, such as condomless anal sex, online social networking, chemsex, and group sex. Viral clearance of primary HCV infection may occur spontaneously or after treatment, but it does not confer immunity against subsequent HCV reinfection. Molecular epidemiology has revealed regional differences in major circulating variants, and the complexity of HCV transmission networks between IDU and MSM communities. Current HCV guidelines recommend one-time, routine HCV testing for all individuals aged 18 years and older. Periodic repeat HCV testing should be provided to individuals with at-risk behaviors or exposures. Annual HCV testing is recommended for HIV-positive individuals with ongoing risk. HCV testing should be initiated with anti-HCV antibody, and followed by a confirmatory nucleic acid test for HCV (HCV RNA). For individuals with immunocompromised status, HCV exposure within the past 6 months, and HCV reinfection, testing for HCV RNA should be performed. Patients with acute HCV infection should be treated with the same regimens that are recommended for chronic HCV infection. Test and treaf strategy, without awaiting spontaneous resolution, has been shown to be cost-effective and lead to micro-elimination.
Publisher
Society of Internal Medicine of Taiwan
Type
journal article