Estimating the Time to Diagnosis and the Chance of Spontaneous Clearance During Acute Hepatitis C in Human Immunodeficiency Virus-Infected Individuals

Authored by Sylvie Deuffic-Burban, Yazdan Yazdanpanah, Romain Ragonnet, Christoph Boesecke, Marguerite Guiguet, Karine Lacombe, Jeremie Guedj, Juergen K Rockstroh

Date Published: 2017

DOI: 10.1093/ofid/ofw235

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Model Documentation: Other Narrative

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Abstract

Background. Hepatitis C virus (HCV) infection is often asymptomatic, and the date of infection is almost impossible to determine. Furthermore, spontaneous clearance (SC) may occur, but little is known about its time of occurrence. Methods. Data on human immunodeficiency virus (HIV)-HCV coinfected individuals were used to inform a stochastic simulation model of HCV viral load kinetics, alanine aminotransferase (ALT), and HCV antibodies during acute hepatitis C. The dates of diagnosis and potential SC were estimated through a Bayesian approach. Hepatitis C virus diagnosis was assumed to be based on an elevated ALT level detected during a control visit for HIV-infected individuals, which occurred every 3 months (scenario A) or every 6 months (scenario B). Results. We found that HCV diagnosis occurred after a median of 115 days and 170 days of infection in scenarios A and B, respectively. Among spontaneous clearers, SC occurred after a median time of 184 days after infection. Seven percent (scenario B) to 10\% (scenario A) of SCs appeared more than 6 months after diagnosis, and 3\% (both scenarios) of SCs appeared more than 1 year after diagnosis. Conclusions. Acute hepatitis C diagnosis occurs late in HIV-HCV coinfected individuals. Screening for HCV in HIV-infected individuals should be performed frequently to reduce delays. Our findings about late occurrence of SC support ``wait and see{''} strategies for treatment initiation from an individual basis. However, early treatment initiation may reduce HCV transmission.

Tags

Agent-based modeling Dynamics population Diseases Responses Viral load Men Natural-history Hcv antibodies Late diagnosis Natural history Acute hcv infection Hiv-positive msm Acute-phase