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Table 1 Diagnostic procedures for hepatitis C in HIV co-infection

From: The treatment of chronic hepatitis C virus infection in HIV co-infection

Diagnosis of hepatitis C

   HCV-Ab (positive 1-5 months after infection, may rarely be lost with immunosuppression)

   HCV-RNA levelsa (in particular predicts response to treatment)

Status of liver damage

   Grading of fibrosis (e. g. FibroScan, liver biopsy, serum fibrosis markersb)

   Hepatic synthetic function (e. g. coagulation, albumin, CHE)

   Ultrasound and AFP every 6 months in cirrhotics (gastroscopy upon diagnosis of cirrhosis and every 1-2 years thereafter)

Before HCV treatment

   HCV genotype and serum HCV-RNA

   Autoantibodies (ANA, LKM1)c

   TSH, thyroid autoantibodies

Monitoring of HCV treatment

   Differential blood count and liver enzymes every 2-4 weeks

   HCV-RNA at week 4 (to evaluate rapid virological response), and weeks 12, 24, and 48 (72 if applicable) and 24 weeks after stopping HCV therapy

   CD4-count every 12 weeks

   TSH every 12 weeks

  1. Recommendations according to the current EACS guidelines on the treatment of HIV/HCV co-infection.
  2. a) Low viral load defined as less than 400,000 - 500,000 IU/ml when using PegINF+RBV. There is no standard conversion formula for converting the amount of HCV-RNA reported in copies/ml to the amount reported in IU/ml. The conversion factor ranges from about one to five HCV-RNA copies per IU/ml.
  3. b) Serum fibrosis markers include APRI, FIB-4, Hyaluronic acid, Fibrometer, Fibrotest, Forns, Hepascore and other indices; recently more complex tests such as Fibrometer, Fibrotest and Hepascore have shown to more accurately predict liver fibrosis than simple biochemical tests such as APRI, FIB-4 or Forns.
  4. c) Patients with positive anti LKM or ANA with homogeneous pattern should be evaluated for concurrent autoimmune hepatitis especially in the presence of ALT elevation during treatment.