Targeted Screening
Approximately 50% of persons with chronic HCV are unaware of their infection.5  Only about 2/3 of chronically infected individuals develop symptoms of infection, and these symptoms are often non-specific malaise and fatigue.8 The CDC states that "[t]esting persons  in settings with potentially high proportions of injecting-drug users (e.g., correctional institutions, HIV counseling and testing sites, or drug and STD treatment programs) might be particularly efficient for identifying HCV-positive persons."9

Cost associated with HCV screening can be reduced by focusing on certain sub-populations that have particularly high prevalence of HCV infection (see HEPP News April 2001 p2).10 There are a variety of tests available for diagnosing HCV. Enzyme immunoassay (EIA) is the most cost-effective screening test; recombinant immunoblot assay (RIA) helps confirm positive EIA results, while polymerase chain reaction (PCR) is the "gold standard" for confirming active HCV infection with viral replication. In rare cases, the HCV antibody tests can give false negatives. Repeat antibody or viral load testing may be necessary when there is a significant suspicion of HCV infection in HIV infected patients, as low CD4 T cell counts have also been associated with false negative HCV antibody and PCR tests.8, 11, 12

Testing for hepatitis infection informs the patient and physician about the potential for and possible existence of liver damage, and it should serve as an important prompt for a discussion about risky behaviors (particularly if the patient is not yet HCV infected), of factors associated with more rapid progression of HCV disease (such as alcohol abuse) and about the potential for transmission to others.13

CONTINUE...
 

• HCV Epidemiology
• Inmates at Risk
• Targeted Screening
• Who Should Get Treated?
• Shifting Standards for Treatment of HCV
• Expect Delays
• Length of Treatment
• Expected Outcome
• Liver Biopsy
• HIV/HCV Coinfection
• HIV/HCV Response Therapy
• Cost of Treatment
• Management
• New Guidelines for Corrections
• Conclusion
• References
• Figures 1, 2 & 3
• Box 1 & 2
• Tables 1 & 2

HEPP News is published twelve times a year by the: HIV Education/Prison Project at the Brown University AIDS Program Box G-B426 Brown University Providence, Rhode Island 02912 401-863-2180 fax 401-863-1243 heppnews@brown.edu