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Risk score accurately predicts acute HCV risk in MSM with HIV

Researchers from the Netherlands developed a new risk score that accurately predicted the risk for acute HCV infection in men with HIV who have sex with men, according to an abstract presented at AIDS 2016.

“Using this risk score, between 42% and 59% of HIV-infected MSM would be advised to undergo HCV testing, correctly identifying between 73% and 100% of HCV patients, potentially making it a useful tool to assist testing for acute HCV infection,” Astrid M. Newsum, MD/PhD candidate at the Academic Medical Center and Public Health Service in Amsterdam, told Healio.com/Hepatology. “There is, however, a proportion of HCV cases that will be missed when using the risk score; it should therefore be used as an additional tool rather than a replacement of testing practices in HIV clinics.”

Astrid M. Newsum

The AASLD/IDSA/IAS-USA guidelines recommend annual HCV testing of MSM with HIV who have unprotected sex. To target those at highest risk for HCV, researchers have already developed several risk scores. However, no score has been developed for acute HCV in MSM with HIV.

Newsum and colleagues developed their risk score using data from self-administered questionnaires from the MOSAIC study in the Netherlands. Each patient’s individual score was calculated based on six risk factors: receptive anal intercourse without a condom, sharing of sex toys, fisting without gloves, injection drug use, sharing straws while snorting drugs and self-reported ulcerative sexually transmitted infection. This score was validated among MSM with HIV from case-control studies in Belgium and the U.K. as well as from cross-section surveys at an STI clinic in the Netherlands.

At the optimal cut-off, between 42% and 59% of individuals in the study would be advised to undergo testing for acute HCV. Further, the sensitivity of the score was 78% and the specificity was 78.6%. In the validation studies, sensitivity ranged from 73.1% to 100% and specificity from 56.2% to 65.5%. The post-test probability of HCV ranged between 5.9% and 20%, which yields a diagnostic gain between 4.2% and 13.6%.

“Our risk score could be implemented in settings where HIV-infected MSM are being tested for STIs and where HCV is not routinely measured, like STI clinics,” Newsum said. “A risk score could identify those at highest risk for acute HCV infection, potentially lowering costs and enhancing implementation of acute HCV testing.” – by Will Offit

Reference:

Newsum AM, et al. Abstract 1564. Presented at: AIDS 2016 Annual Meeting; July 18-22, 2016; Durban, South Africa.

Disclosure: Newsum reports that this research was supported by the “Aids Fonds” Netherlands, the Research and Development Foundation of the Public Health Service of Amsterdam and Gilead Sciences Netherlands BV and AbbVie BV.