| TABLE 1: DIAGNOSTIC PROCEDURES FOR HEPATITIS C IN HIV CO-INFECTION |
| Diagnosis of hepatitis C |
| HCV-Ab (positive 1-5 months after infection, may rarely be lost with immunosuppression) |
| HCV-RNA levels a (in particular important for the prediction of response to treatment) |
| STATUS OF LIVER DAMAGE |
| Grading of fibrosis (e. g. FibroScan, liver biopsy, serum fibrosis markers b) |
| 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 |
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| 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. |
| 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. |
| 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. |
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