Development and validation of the HCV-MOSAIC risk score to assist testing for acute hepatitis C virus (HCV) infection in HIV-infected men who have sex with men (MSM)

Astrid M Newsum, Ineke G Stolte, Jan Tm van der Meer, Janke Schinkel, Marc van der Valk, Joost W Vanhommerig, Anne Buvé, Mark Danta, Arjan Hogewoning, Maria Prins, MOSAIC collaborators, J T M van der Meer, R Molenkamp, M Mutschelknauss, H E Nobel, H W Reesink, J Schinkel, M van der Valk, J W Vanhommerig, G E L van den Berk, K Brinkman, D Kwa, N van der Meché, A Toonen, D Vos, M van Broekhuizen, F N Lauw, J W Mulder, J E Arends, A van Kessel, I de Kroon, A Boonstra, M E van der Ende, S Hullegie, B J A Rijnders, T J W van de Laar, L Gras, C Smit, A M Newsum, M Prins, W van der Veldt, Astrid M Newsum, Ineke G Stolte, Jan Tm van der Meer, Janke Schinkel, Marc van der Valk, Joost W Vanhommerig, Anne Buvé, Mark Danta, Arjan Hogewoning, Maria Prins, MOSAIC collaborators, J T M van der Meer, R Molenkamp, M Mutschelknauss, H E Nobel, H W Reesink, J Schinkel, M van der Valk, J W Vanhommerig, G E L van den Berk, K Brinkman, D Kwa, N van der Meché, A Toonen, D Vos, M van Broekhuizen, F N Lauw, J W Mulder, J E Arends, A van Kessel, I de Kroon, A Boonstra, M E van der Ende, S Hullegie, B J A Rijnders, T J W van de Laar, L Gras, C Smit, A M Newsum, M Prins, W van der Veldt

Abstract

Current guidelines recommend hepatitis C virus (HCV) testing for HIV-infected men who have sex with men (MSM) with ongoing risk behaviour, without specifying the type of risk behaviour. We developed and validated the HCV-MOSAIC risk score to assist HCV testing in HIV-infected MSM. The risk score consisted of six self-reported risk factors identified using multivariable logistic regression using data from the Dutch MOSAIC study (n = 213, 2009-2013). Area under the ROC curve (AUC), sensitivity, specificity, post-test-probability-of-disease and diagnostic gain were calculated. The risk score was validated in case-control studies from Belgium (n = 142, 2010-2013) and the United Kingdom (n = 190, 2003-2005) and in cross-sectional surveys at a Dutch sexually transmitted infections clinic (n = 284, 2007-2009). The AUC was 0.82; sensitivity 78.0% and specificity 78.6%. In the validation studies sensitivity ranged from 73.1% to 100% and specificity from 56.2% to 65.6%. The post-test-probability-of-disease ranged from 5.9% to 20.0% given acute HCV prevalence of 1.7% to 6.4%, yielding a diagnostic gain of 4.2% to 13.6%. The HCV-MOSAIC risk score can successfully identify HIV-infected MSM at risk for acute HCV infection. It could be a promising tool to improve HCV testing strategies in various settings.

Keywords: MSM; clinical prediction rule; diagnosis; hepatitis C; risk score; testing.

Conflict of interest statement

Conflict of interest: MV served on a scientific advisory board for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Johnson and Johnson, MSD and a data safety monitoring board for ViiV healthcare. Through his institution he received non-financial support by MSD. The remaining authors (AN, IS, JM, JS, JV, AB, MD, AH, MP) declared no conflict of interest.

This article is copyright of The Authors, 2017.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves for the original and HCV-MOSAIC risk score in the development study (A) and for the HCV-MOSAIC risk score in the three validation studies (B–D)
Figure 2
Figure 2
Fagan’s nomogram for a risk score of ≥ 2.0

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