Testing Strategies for HIV and HCV: similarities and differences - Dr Chloe Orkin
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This document discusses testing strategies for HIV and HCV, highlighting some key similarities and differences. It notes that while HIV mortality has declined since 2000, HCV deaths are increasing in Western Europe. The HIV care cascade shows 76% of people living with HIV in the UK are diagnosed, while only around 50% of the estimated 214,000 people living with HCV have been diagnosed. Screening is the first step of the care cascade but current strategies are failing to diagnose around 90% of cases. While HIV testing occurs in various settings like hospitals and the community, HCV testing guidelines in the UK currently recommend targeted testing of at-risk groups rather than universal screening, as is recommended in the US for baby boomers due to the high prevalence in that
Testing Strategies for HIV and HCV: similarities and differences - Dr Chloe Orkin
- 1. Testing Strategies for HIV and HCV: similarities and differences Dr Chloe Orkin Consultant Physician & Honorary Reader in HIV Medicine Barts Health NHS Trust
- 2. Deaths attributable to HIV and Hepatitis in Western Europe Global Burden of Disease Study: Cowie et al J Hep 2014 ;60 (Suppl 1):O86 -A relatively higher burden of HIV-related mortality until 1995 -HIV mortality declines from 2000 onwards -HCV deaths increasing
- 3. HIV care cascade - WHO target WHO consolidated guidelines on HIV testing services. July 2015.
- 4. HIV care cascade - UK Public Health England. HIV in the United Kingdom 2014 report. November 2014. 76%
- 5. HCV care cascade in the UK 1. Public Health England. Hepatitis C in the UK 2015 report. July 2015. 2. Harris RJ et al. J Hepatol 2014;61:530–7. SVR ~50% 3% 63% 214,000 with HCV1 ~100,000 diagnosed 6000 per year2 ‘The great unknown’ svr
- 6. HIV/HCV cascades: failing to diagnose 90% …. screening is the first step… TESTING SCREENING ASSESSMENT TREATMENT CURE
- 7. HIV - where does testing happen in the UK ?
- 8. UK HIV testing summary • HIV seroprevalence data underpins testing strategies • HIV testing occurring (hospital/community) • Tailor testing methods to the setting: oral swabs /rapid tests in outreach/STI vs. serology in ante-natal or the ED • De-exceptionalising HIV testing is important in non-traditional settings • Staff perceptions affect successful implementation • Sustainability is a key challenge in non-traditional settings such as the ED/MAU/ITU • HIV testing has moved beyond non-traditional settings into ‘DIY’ testing
- 9. UK Guidelines HCV Testing = targeted testing At-risk populations: • PWID (about 90% being tested 1) • Prisons (8% of receptions tested within 30 days1) • Immigration centres • ‘Promote’ in GUM to those at high risk 1. Cosgrove P. Public health England Report: Hepatitis Epidemiology in the South East
- 10. HCV Epidemic UK : gender
- 11. UK Epidemic: Ethnicity Proportion testing positive for HCV-Ab by ethnicity in sentinel laboratories in the South East , 2010-2014
- 12. Generalised epidemic= universal screening • Targeted testing not helpful • Universal approach
- 13. US HCV: screening amongst ‘baby-boomers’ • Prevalence in this cohort > 3% • One time ‘birth cohort’ screening if born 1945–65 • Highly cost-effective Centers for Disease Control and Prevention. MMWR 2012;61:1–33. Centers for Disease Control and Prevention. MMWR 1998;47:1–39. Smith BD et al. AASLD 2011. Abstract 394.
- 14. Differences in testing in the UK HCV HIV
- 15. Are we missing HCV cases? Sero-prevalence surveys are helpful
Editor's Notes
- #4: Notably, in 2014 around 90% of those diagnosed with HIV in the UK had initiated ART, with 93% of those on ART having a suppressed viral load . The number of people living with HIV in the UK continues to increase and by the end of 2013 was estimated to be 107,800 (95% credible interval 101,600-115,800) of whom 24% were undiagnosed.
- #5: Notably, in 2014 around 90% of those diagnosed with HIV in the UK had initiated ART, with 93% of those on ART having a suppressed viral load . The number of people living with HIV in the UK continues to increase and by the end of 2013 was estimated to be 107,800 (95% credible interval 101,600-115,800) of whom 24% were undiagnosed.
- #6: Notably, in 2014 around 90% of those diagnosed with HIV in the UK had initiated ART, with 93% of those on ART having a suppressed viral load . The number of people living with HIV in the UK continues to increase and by the end of 2013 was estimated to be 107,800 (95% credible interval 101,600-115,800) of whom 24% were undiagnosed. 215,000 + 100,000 tested Treated
- #7: CCO – Thomas illustration
- #10: MSM 75 non injecting 33 injecting 86 under influence of drugs High proportions of UPSI