Tsai, Tsung-YuTsung-YuTsaiChen, Guan-JhouGuan-JhouChenHSIN-YUN SUNCHIEN-CHING HUNG2025-12-092025-12-092025-10https://scholars.lib.ntu.edu.tw/handle/123456789/734459Background. Hepatitis C virus (HCV) core antigen (HCVcAg) has been validated to identify HCV infection, but its efficacy in diagnosing acute HCV infection among people with HIV-1 (PWH) warrants further investigation. This systematic review and meta-analysis aimed to evaluate the diagnostic performance of HCVcAg for acute or recent HCV infection among PWH. Methods. We conducted a literature search to identify studies assessing the diagnostic performance of HCVcAg from January 2020 to May 2024. Acute or recent HCV infection was defined as the presence of negative anti-HCV antibody but positive nucleic acid amplification tests (NAATs), or anti-HCV antibody seroconversion within 1 year. Studies were included if they evaluated HCVcAg diagnostic accuracy using NAATs as the gold standard and provided sufficient data for sensitivity and specificity assessment. Studies lacking a clear definition of acute or recent infection were excluded. Results. Four out of 229 articles met our inclusion criteria, with 1015 participants providing 1796 tests. The sensitivity of HCVcAg to diagnose acute or recent HCV infection ranged from 87.1% to 100% and specificity from 95.0% to 100%. The meta-analysis yielded a pooled sensitivity of 0.92 (95% CI, 0.78–0.98) and specificity of 0.99 (95% CI, 0.97–1.00). Based on the global incidence (8.46 per 1000 person-years) of HCV viremia among PWH, the positive and negative predictive values of HCVcAg were 0.44 (95% CI, 0.18–1.00) and 1.00 (95% CI, 0.99–1.00), respectively. Conclusions. HCVcAg has good diagnostic performance in identifying PWH with acute or recent HCV infection, supporting its integration into HCV screening protocols for PWH.ennegative likelihood rationegative predictive valuepositive likelihood ratiopositivity predictive valuereinfectionsexually transmitted infection[SDGs]SDG3journal article10.1093/ofid/ofaf57641113326