Annual HCV Screening Recommended in NYS for HIV+ For At-Risk Individuals

Annual HCV Screening Recommended in NYS for HIV+ For At-Risk Individuals

Hepatitis and HIV: Update to Hepatitis C
Virus in HIV-Infected Patients


As part of Hepatitis Awareness Month, the Office of the Medical Director, New York State Department of Health AIDS Institute, is pleased to announce guidelines updates from the Medical Care Criteria Committee, chaired by Barry S. Zingman, MD.
CLINICAL GUIDELINES UPDATE: HEPATITIS C VIRUS
Significant revisions include the following:

* An annual HCV antibody test is now recommended for HIV-infected patients who have continued high-risk behaviors but are seronegative for HCV; such individuals include:
o Injection drug users
o Men who have sex with men without barrier protection
o Anyone with multiple sexual partners

* Quantitative HCV RNA viral load testing is now recommended for HIV-infected patients:
o To confirm a reactive HCV ELISA antibody screen
o To exclude HCV infection in those who are seronegative for HCV but have risk factors for HCV exposure and unexplained liver disease, including increased serum liver enzymes

* A table has been added that lists the tests for measuring HCV RNA (see Table 1)

* Figure 1. HCV Testing Algorithm for HIV-Infected Patients has been updated

* Assessment for anti-HCV therapy is now recommended for HIV-infected patients with acute HCV infection (see Section VI. B. Assessment for Treatment of Acute HCV Infection)

* Sections on assessment of mental health disorders and alcohol and substance use have been added (see Sections V. F. Assessment of Mental Health Disorders and G. Assessment of Alcohol and Substance Use)

* A new section has been added on ongoing evaluation of patients when anti-HCV therapy is deferred (see Section VII)

* A new section has been added that outlines baseline assessments and counseling at initiation of therapy (see Section VIII)

* Consultation with a psychiatrist is now recommended when prescribing anti-HCV therapy for HIV-infected patients with mental health disorders

* Figure 2. Initial Anti-HCV Therapy for HIV/HCV Co-infected Patients has been updated and now recommends determining whether or not to continue anti-HCV treatment after week 12 by assessing for virologic response according to quantitative HCV RNA

* A table has been added that outlines strategies for managing side effects of anti-HCV therapy (see Table 7)

CLINICAL GUIDELINES UPDATE: OCCUPATIONAL AND NON-OCCUPATIONAL EXPOSURES TO HEPATITIS B AND HEPATITIS C
These sections provide guidance on post-exposure management for hepatitis B and C virus, including the following:

* Initiation of prophylaxis and the hepatitis B vaccine series for non-HBV-immune persons who sustain a blood or body fluid exposure (see Table 8)
* Baseline tests to obtain following a potential hepatitis C exposure and management according to results (see Table 9)
* Post-exposure follow-up schedule for individuals exposed to hepatitis C

OTHER HIV AND HEPATITIS CLINICAL GUIDELINES FROM THE NYSDOH AIDS INSTITUTE
Hepatitis A Virus

These guidelines recommend that clinicians:

* Vaccinate all HIV-infected patients who are negative for HAV IgG
* Obtain post-vaccination antibody measurements in patients who are at increased risk for hepatitis A infection to verify vaccine efficacy and to identify patients who might benefit from vaccine boosting. Persons who are at increased risk are listed in Table 1.

Hepatitis B Virus

These guidelines include recommendations that address the following:

* The HBV serologies that should be obtained prior to vaccination and when to obtain serologies after vaccination (see Figure 3)
* When to initiate treatment active against HBV (see Section VI)
* When to initiate ARV therapy in HIV/HBV co-infected patients (see Section VI)
* Routine laboratory assessment and therapeutic monitoring considerations of HIV-infected patients with HBV (see Table 3)