Diagnosis and Assessment
8
Î Patients who are negative for HBsAg and HBsAb but positive for anti-
HBc should be screened for chronic HBV infection by determination of
HBV DNA. Those without evidence of chronic infection should consider
vaccination (SR-L).
Î HIV-infected patients should be screened for hepatitis C virus (HCV)
infection upon initiation of care by a test for HCV antibody and
annually thereafter for those at risk (SR-H).
Î HCV RNA testing should be ordered on all those with a positive HCV
antibody test result to assess for active HCV disease (SR-H).
Î Infants born to HBV- and/or HCV-infected women should be tested for
HBV and HCV transmission, respectively (SR-H).
Î Hepatitis A vaccination is recommended for all susceptible men who
have sex with men (MSM), as well as other susceptible individuals
with indications for hepatitis A vaccine (eg, injection drug users,
persons with chronic liver disease, travelers to countries with high
endemicity, or patients who are infected with hepatitis B and/or C)
(SR-H). Hepatitis A total or IgG antibody testing should be repeated
1-2 months after the second vaccine is given, or at the next scheduled
visit after the second vaccine is given, to assess for immunogenicity.
A repeat vaccine series is recommended in those who remain
seronegative (SR-H).
Î Hepatitis A vaccine may be considered for all other nonimmune
patients (negative anti-HAV [hepatitis A virus] total or IgG antibody)
(WR-L).
Screening and Vaccination Recommendations for Herpes Viruses
Î Patients at lower risk of cytomegalovirus (CMV) infection (eg,
populations other than MSM or injection drug users, both of which
may be assumed to be seropositive) should be tested for latent CMV
infection with an anti-CMV IgG upon initiation of care (SR-M).
Î Patients who are susceptible to varicella zoster virus (VZV) (those who
have not been vaccinated, have no history of varicella or herpes zoster
infection, or are seronegative for VZV) should receive postexposure
prophylaxis with varicella zoster immune globulin (VariZIG
®
) as soon
as possible (but within 10 days) after exposure to a person with
varicella or shingles (SR-M).
Î Varicella primary vaccination may be considered in HIV-infected,
VZV-seronegative persons >8 years of age with CD4 cell counts
>200/μL (MR-L) and in HIV-infected children ages 1-8 years with CD4
cell percentages >15% (SR-M).
