Clinical variables identify seronegative HCV co-infection in HIV-infected individuals
Clinical variables identify seronegative HCV co-infection in HIV-infected individuals
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DOI：
10.1016/j.jcv.2011.08.021
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发表时间：
2011-12-01
影响因子：
8.8
通讯作者：
Grant, Igor
中科院分区：
文献类型：
--
作者：
Bharti, Ajay R.;Letendre, Scott L.;Grant, Igor
背景：相当数量的艾滋病毒感染者（PLWH）合并感染丙型肝炎病毒（HCV），但筛查HCV抗体测试呈阴性（血清阴性HCV感染，或SN-HCV）。目的：确定一组简明的临床变量，可用于改善PLWH中SN-HCV合并感染的病例发现。研究设计：根据与丙型肝炎病毒感染相关的7个临床变量选择了200名丙型肝炎病毒血清阴性的CHARTER研究的hiv感染者。数据分析采用Fisher精确检验、受试者工作特征（ROC）曲线和逻辑回归。结果：26名（13%）参与者检测到HCV RNA。SN-HCV与IDU史、ALT和AST升高、血小板低、黑人和血浆中检测不到HIV RNA相关。在多因素logistic回归分析中，除AST异常外，这些临床变量均与SN-HCV独立相关。综合风险评分正确识别SN-HCV，灵敏度高达85%，特异性高达88%。结论：在相当少数的PLWH患者中，血清阴性HCV病毒血症可以通过少量临床变量预测。这些发现在未经选择的队列中得到验证后，可以帮助将筛查重点放在高危人群上。(C) 2011 Elsevier B.V.版权所有
Background: A substantial number of people living with HIV (PLWH) are co-infected with Hepatitis C Virus (HCV) but have a negative screening HCV antibody test (seronegative HCV infection, or SN-HCV).Objective: To identify a concise set of clinical variables that could be used to improve case finding for SN-HCV co-infection among PLWH.Study design: Two hundred HIV-infected participants of the CHARTER study were selected based on 7 clinical variables associated with HCV infection but were HCV seronegative. Data were analyzed using Fisher's exact tests, receiver-operating characteristic (ROC) curves, and logistic regression.Results: Twenty-six (13%) participants had detectable HCV RNA. SN-HCV was associated with a history of IDU, elevated ALT and AST, low platelets, black ethnicity, and undetectable HIV RNA in plasma. Each of these clinical variables, except for abnormal AST, remained independently associated with SN-HCV in a multivariate logistic regression analysis. A composite risk score correctly identified SN-HCV with sensitivity up to 85% and specificity up to 88%.Conclusions: In a substantial minority of PLWH, seronegative HCV viremia can be predicted by a small number of clinical variables. These findings, after validation in an unselected cohort, could help focus screening in those at highest risk. (C) 2011 Elsevier B.V. All rights reserved.