Estimating the time to diagnosis and the chance of spontaneous clearance during acute hepatitis C in human immunodeficiency virus-infected individuals

Romain Ragonnet, Sylvie Deuffic-Burban, Christoph Boesecke, Marguerite Guiguet, Karine Lacombe, Jeremie Guedj, Jürgen K. Rockstroh, Yazdan Yazdanpanah

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
Article numberofw235
Number of pages7
JournalOpen Forum Infectious Diseases
Volume4
Issue number1
DOIs
Publication statusPublished - 1 Jan 2017
Externally publishedYes

Keywords

  • Agent-based modeling
  • HCV antibodies
  • Late diagnosis
  • Natural history
  • Viral load

Cite this

Ragonnet, Romain ; Deuffic-Burban, Sylvie ; Boesecke, Christoph ; Guiguet, Marguerite ; Lacombe, Karine ; Guedj, Jeremie ; Rockstroh, Jürgen K. ; Yazdanpanah, Yazdan. / Estimating the time to diagnosis and the chance of spontaneous clearance during acute hepatitis C in human immunodeficiency virus-infected individuals. In: Open Forum Infectious Diseases. 2017 ; Vol. 4, No. 1.
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Estimating the time to diagnosis and the chance of spontaneous clearance during acute hepatitis C in human immunodeficiency virus-infected individuals. / Ragonnet, Romain; Deuffic-Burban, Sylvie; Boesecke, Christoph; Guiguet, Marguerite; Lacombe, Karine; Guedj, Jeremie; Rockstroh, Jürgen K.; Yazdanpanah, Yazdan.

In: Open Forum Infectious Diseases, Vol. 4, No. 1, ofw235, 01.01.2017.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Estimating the time to diagnosis and the chance of spontaneous clearance during acute hepatitis C in human immunodeficiency virus-infected individuals

AU - Ragonnet, Romain

AU - Deuffic-Burban, Sylvie

AU - Boesecke, Christoph

AU - Guiguet, Marguerite

AU - Lacombe, Karine

AU - Guedj, Jeremie

AU - Rockstroh, Jürgen K.

AU - Yazdanpanah, Yazdan

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - Agent-based modeling

KW - HCV antibodies

KW - Late diagnosis

KW - Natural history

KW - Viral load

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DO - 10.1093/ofid/ofw235

M3 - Article

VL - 4

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

SN - 2328-8957

IS - 1

M1 - ofw235

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