Triple testing for HIV, HBV, HCV at once would help identify more cases across populations

January 23, 2024

2 min read

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Key takeaways:

• Triple testing for HIV, HBV and HCV would identify an additional five HBV and three HCV cases for each HIV case.
• It would cost less than $2 more to test for all three viruses as opposed to just HIV.

Study results suggest that WHO’s triple testing campaign for HIV, hepatitis B and hepatitis C should be expanded and not just target the three groups WHO listed to be most at risk, researchers said.

“This study was prompted by the vast differences in HIV and hepatitis B and hepatitis C diagnoses and treatment,” Natasha Beard, BSc, medical student at the Imperial College London, told Healio. “Whilst 85% of people living with HIV have been diagnosed, only 10.5% of people living with hepatitis B and 21% of people living with hepatitis C have received diagnoses. Similarly, 75% of people living with HIV are receiving treatment, yet only 2.2% of people living with hepatitis B and 21% of people living with hepatitis C are receiving treatments.”

Beard N, et al. Open Forum Infect Dis. 2024;doi:10.1093/ofid/ofad666.

 

She added that, “as a result, it is estimated that by 2040, viral hepatitis will result in more deaths annually than the HIV, malaria, and tuberculosis epidemics combined.”

Beard and Andrew Hill, MD, senior visiting Research Fellow in the Pharmacology Department at Liverpool University, conducted a systematic review assessing the prevalence of HIV, HBV and HCV in nine different population groups including blood donors, general population, health care attendees, individuals experiencing homelessness, men who have sex with men (MSM), people who use drugs, pregnant people, prisoners and refugees, to provide justification for the WHO’s new triple testing campaign.

The campaign, which the authors explained consists of guidelines from WHO recommending triple testing for people who use drugs, MSM and prisoners, was introduced to 2022.

Beard and Hill searched MEDLINE, Embase and Global Health to identify papers published between Jan. 1, 2013, and Feb. 24, 2023. Papers that were included reported the prevalence of HIV, HBV and HCV.

In total, 175 studies sampling over 14 million people were included. The average prevalence of HIV was 0.22%, HBV was 1.09% and HCV was 0.65%, whereas the average number of people who tested positive for at least one blood-borne virus was 1.9%.

Based on these numbers, Beard and Hill determined that through triple testing, for every case of HIV identified, five would be diagnosed with HBV and three with HCV. They also said that triple testing would not be too costly because testing for all three viruses is available for $2.48 compared with the average cost of $1.00 for the lowest-priced isolated HIV test.

They wrote that these data provide justification for the expansion from HIV to triple testing to all groups, not just WHO’s recommended risk groups.

“The take-home message from this article is that we should build on the pre-existing successful HIV diagnostic pathway and expand this to incorporate testing and treatment for hepatitis B and C,” Beard said. “With the Sustainable Development Goals aiming to combat these three viruses by 2030, the necessity of implementing widespread and low-cost diagnostic and treatment pathways for these three viruses cannot be understated.”

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