Having a High Risk of HCV Does Not Always Lead to Testing Among Those With HIV

Just half of individuals with HIV were ever tested for hepatitis C virus (HCV) in the year after receiving their HIV diagnosis, despite being at increased risk for the liver disease, report recent study results that appeared in Open Forum Infectious Diseases. Living in a rural area, too, meant this patient group was the least likely to get tested.

“Because HIV infection can accelerate the natural history of HCV infection leading to increased risk for cirrhosis, liver failure, and hepatitis C—related mortality, all individuals living with HIV should be tested for hepatitis C and linked to care where appropriate,” the study authors noted.

They extracted their data on 46,277 commercially insured individuals who had 1 or more claims related to an HIV diagnosis between January 1, 2008, and December 31, 2016, from the IBM Watson Health MarketScan database. Claims were identified using International Classification of Diseases, Ninth Revision, Clinical Modifications, or Tenth Revision; Current Procedural Terminology; and the National Drug Codes directory.

All of the patients had to be enrolled in their insurance plans from 6 months before receiving their diagnosis to up to 1 year after (June 7, 2007, to December 2017). The index date was the date that a person received their HIV diagnosis.

The primary study outcomes were 12-month HCV testing rates and demographics associated with HCV testing. Four geographic regions were evaluated, and most of the patient group lived in the South (39%), followed by the Northeast (32%), Midwest (15%), and West (14%).

As noted above, only 50% of the patients with HIV were ever tested for HCV in the 12 months after the index visit for their diagnosis, but this rate increased 13% over the course of the study. Fifty percent were aged 30 to 49 years, with a mean and median age of 38 years.

Women were less likely than men to get tested for HCV (relative risk [RR], 0.79; 95% CI, 0.77-0.81), as were patients aged 50 to 59 years compared with those aged 20 to 29 years: 40% vs 56%. Receiving care in a rural area equated to a lesser likelihood of HCV testing (RR, 0.85; 95% CI, 0.80-0.91).

Overall, the first few years of the study, 2008 through 2014, saw HCV testing rates increase (P < .001), but after that, the rates plateaued and then fell.

“Although there were increases in hepatitis C testing rates over the study period, there remain missed opportunities to detect and treat HCV infection among people newly diagnosed with HIV,” the authors concluded. “Because HIV infection can accelerate hepatitis C related morbidity and mortality, additional efforts are needed to improve hepatitis C testing among people newly diagnosis with HIV.”

To increase uptake of testing in populations with HIV and perhaps come up with solutions to close the gap, they recommend the following:

1. Studies should compare HCV testing rates among patients with a new HIV diagnosis with those 1 year out from their HIV diagnosis.
2. Health care providers should stress the need for HCV testing with their HIV-positive patients who have commercial insurance.
3. Interventions should target how to increase HCV testing among persons who have HIV, especially stressing the effectiveness of direct-acting antiviral drugs.

Reference

King H, Bull-Otterson L, Hoover KH, Huang HYLA, Zhu W, Thompson W. Factors associated with testing for hepatitis C infections among a commercially insured population of persons with HIV, United States 2008—2016. Open Forum Infect Dis. Published online June 6, 2020. doi:10.1093/ofid/ofaa222