Targeted hepatitis C antibody testing interventions: a systematic review and meta-analysis.

Testing for hepatitis C virus (HCV) infection may reduce the risk of liver-related morbidity, by facilitating earlier access to treatment and care. This review investigated the effectiveness of targeted testing interventions on HCV case detection, treatment uptake, and prevention of liver-related morbidity. A literature search identified studies published up to 2013 that compared a targeted HCV testing intervention (targeting individuals or groups at increased risk of HCV) with no targeted intervention, and results were synthesised using meta-analysis. Exposure to a targeted testing intervention, compared to no targeted intervention, was associated with increased cases detected [number of studies (n) = 14; pooled relative risk (RR) 1.7, 95% CI 1.3, 2.2] and patients commencing therapy (n = 4; RR 3.3, 95% CI 1.1, 10.0). Practitioner-based interventions increased test uptake and cases detected (n = 12; RR 3.5, 95% CI 2.5, 4.8; and n = 10; RR 2.2, 95% CI 1.4, 3.5, respectively), whereas media/information-based interventions were less effective (n = 4; RR 1.5, 95% CI 0.7, 3.0; and n = 4; RR 1.3, 95% CI 1.0, 1.6, respectively). This meta-analysis provides for the first time a quantitative assessment of targeted HCV testing interventions, demonstrating that these strategies were effective in diagnosing cases and increasing treatment uptake. Strategies involving practitioner-based interventions yielded the most favourable outcomes. It is recommended that testing should be targeted at and offered to individuals who are part of a population with high HCV prevalence, or who have a history of HCV risk behaviour.

Consecutive infections and clearances of different hepatitis C virus genotypes in an injecting drug user.

BACKGROUND: The hepatitis C virus (HCV) causes significant morbidity and mortality worldwide, and is highly prevalent among injecting drug users (IDUs). Whether initial HCV infection and clearance provides protection from reinfection has not been established, but is an important question for vaccine development. OBJECTIVE: To elucidate an unusual history of HCV infection and clearance in an IDU. STUDY DESIGN: The subject was interviewed and gave blood samples at approximately three-month intervals; all samples were tested for anti-HCV and HCV RNA, genotyped if RNA detected, and checked for mixed genotypes; phylogenetic analysis performed on the subject's and injecting partners' core HCV sequences. RESULTS: We observed consecutive infections with HCV genotypes 3a, 1a and 6l, and intervening clearances, in a young IDU over 449 days. Genotypes 1a and 6l were probably acquired from the subject's injecting partners, who had genetically related infections. CONCLUSION: This case illustrates (1) the ease with which IDUs can acquire HCV, (2) that prior HCV infection does not protect against reinfection with heterologous strains, and (3) that IDUs can clear consecutive HCV infections. Our subject's history of HCV infection and clearance offers hope for vaccine development, yet demonstrates that HCV vaccines must have cross-genotypic effectiveness.