Prevalence of HIV Testing Among Adults with a Hepatitis C Diagnosis: Findings from the National Health and Nutrition Examination Survey 1999 - 2014

Background: Hepatitis C virus (HCV) is a primary cause of chronic liver disease and hepatocellular cancer in the United States. However, health outcomes among persons co-infected with HCV and HIV infections are more severe. HIV treatment with antiretroviral therapy significantly improves health outcomes in HCV/HIV co-infected persons. Although there is currently no guidance on testing HCV-infected persons for HIV, HIV and HCV transmission risks are similar and an HCV diagnosis would indicate a need for HIV testing. We calculated the prevalence of having ever been tested for HIV among HCV-positive adults.

Methods: We analyzed pooled data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and limited the analysis to participants aged 20–59 years (N=26,295) due to age restrictions in the NHANES data. NHANES participants were tested for HCV RNA in human serum or plasma and stratified by test results (“Positive” or “Negative/Indeterminate”). HIV testing prevalence was calculated by demographic and behavioral characteristics (gender, age, race/ethnicity, education, poverty status, injection drug user (IDU), sexual orientation, and number of opposite/same (men only) sex partners in the past 12 months). Chi-square and mean differences were used to determine statistical significance at p<0.05.

Results: An estimated 1.3% of respondents (n = 384) tested positive for HCV infection. Overall, 35.5% of HCV-positive adults had never tested for HIV. Compared with HCV-negative/indeterminate adults, a significantly higher percentage of HCV-positive adults were male, older, non-Hispanic black, less educated, living below poverty, self-identified as gay or bisexual, IDU, and tested for HIV. Among HCV-positive adults, no statistically significant differences by study variables were observed for HIV testing prevalence.

Conclusions: Over one-third of HCV-positive adults had never tested for HIV infection. Strategies are needed to increase HIV testing among all persons infected with HCV to mitigate morbidity and mortality.