CASE REPORT
An unrecognized opportunity to diagnose Hepatitis C Virus (HCV) and decrease transmission in people who inject drugs (PWID) Fig. 1. Right forearm puncture wound and surrounding erythema
ABSTRACT By Heather Henderson, MA, CAS
By Jason Wilson, MD, FACEP, FAAEM
By Kaitlyn Pereira, BS
20
This is a case of a 47-year-old patient who injects drugs (PWID) that presented to the emergency department (ED) with a right arm cellulitis and was diagnosed with acute hepatitis C virus (HCV) seroconversion. The patient presented during a window phase with a negative HCV Ab but detectable HCV RNA PCR. Identification of patients with HCV in PWID decreases viral transmission and provides opportunities for linkage to care, leading to improved rates of sustained virologic response (SVR)1. The HCV screening algorithm2 may not capture all opportunities for diagnosis in high pretest probability PWID patients during ED encounters. In patients at high risk for acute seroconversion (testing prior to time to mount antibody response), an under-recognized window phase may lead to a false negative classification of HCV status. Thus, when testing high pretest probability patients for HCV, providers should consider ordering a HCV RNA even if the HCV Ab is nonreactive. Routine screening for HCV did not identify the infection because the EMpulse Spring 2021
patient had not yet seroconverted. Studies have shown3,4,5 that ordering an HCV RNA PCR may uncover previously unidentified HCV infections in PWID. Earlier detection of HCV status in patients during acute seroconversion may lead to decreased transmission of HCV in needle sharing networks, as well as improved chances of linkage to care for treatment and increases chances of obtaining SVR by 26%.6
INTRODUCTION
Persons who inject drugs (PWID) represent most people with hepatitis C virus (HCV), as intravenous drug use (IVDU) has become the primary route of HCV transmission.1,7 Identification of patients with HCV decreases transmission throughout PWID needle sharing networks and provides opportunities for linkage to care and treatment that can lead to sustained virologic response (SVR) through the use of direct acting antivirals (DAA) which are 95% effective even among PWID.8 The HCV screening algorithm, which does in-