Usually a patient is screened for infection with hepatitis C virus (HCV) based on the presence or absence of anti-HCV antibodies. Chamie et al identified HIV-positive patients who may be negative for these antibodies yet have HCV hepatitis. The authors are from the University of California in San Francisco, multiple hospitals in San Francisco and Oakland, the University of Iowa and Washington University in St.Louis.


Patient selection: HIV-positive patient who is seronegative for HCV



(1) risk factors for HCV infection

(2) evidence of hepatitis

(3) risk factors for depressed antibody levels


Risk factors for HCV infection include injection drug use (IDU).


Evidence of hepatitis is based on elevation of ALT, typically in association with elevation of other liver function tests.


A CD4 positive lymphocyte count < 200 per µL was used as the marker for depressed antibody production.


HCV RNA testing was recommended in an HIV-positive patient with both of the following:

(1) with risk factors for HCV

(2) either an elevated serum ALT concentration or a CD4 cell count < 200 per µL.


The authors found that a quarter of patients meeting these criteria were positive for HCV RNA.


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