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Clinical Guidelines Update: Hepatitis C Virus in HIV-Infected Patients

May 2010

What's New

[Editor's Note: You can download a PDF of the full revised guidelines.]

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:
    • Injection drug users
    • Men who have sex with men without barrier protection
    • Anyone with multiple sexual partners

  • Quantitative HCV RNA viral load testing is now recommended for HIV-infected patients:
    • To confirm a reactive HCV ELISA antibody screen
    • 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)


  
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This article was provided by New York State Department of Health AIDS Institute.
 
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