P5.022 Earlier HCV Diagnosis by the Introduction of Routine HCV Testing For HIV Positive MSM and MSM Opting Out For HIV in a Large STI Outpatient Clinic

Abstract

Background: In October 2007 at a large STI outpatient clinic (SOC), anti-HCV screening was introduced for HIV unaware MSM opting-out for HIV testing (MOH) and HIV-positive MSM. We evaluated whether this screening resulted in additional and earlier HCV diagnosis in HIV-positive MSM also attending HIV treatment centres (HTC). Methods: At first visit, MOH and HIV-positive MSM visiting the SOC in Amsterdam were screened for anti-HCV. During follow-up visits, only those previously HCV negative were tested. Retrospectively, date of new HCV diagnosis at SOC was compared with HCV data provided by HTC. Results: The anti-HCV prevalence at first screening was 0.7% (3/450) among MOH and 6.4% (112/1,742) among HIV-positive MSM of whom 30% (34/112) did not report a history of HCV. In 133 follow-up visits to MOH 0 and in 3,286 follow-up visits to HIV-positive MSM 52 HCV seroconversions were found. These 52 seroconverters and the 34 MSM anti-HCV positive at first screening, excluding 13 MSM who were detected at HTC before SOC started anti-HCV screening, were compared with HTC data. Additional data from HTC was available for 56/73 clients. 29/56 (52%) were first diagnosed at SOC: 7 were concurrently diagnosed with HIV and not in care at HTC; 11 were scheduled for a routine visit at HTC within 1 month; 3 within 3 months; 3 within a year and all 17 were tested and diagnosed with HCV at HTC because of elevated ALT values; 3 HCV diagnoses would have been missed because ALT was low or considered non-HCV related; 2 missed ALT data. Conclusions: The introduction of routine HCV-antibody screening in SOC resulted in additional and earlier diagnoses of HCV in MSM. Testing should focus on HIV-positive MSM especially those newly diagnosed with HIV. Since anti-HCV testing does not identify acute infections, additional testing policies should be evaluated at SOC.