As false positive reactivity is possible with antibody screening tests, positive antibody status should be confirmed in patients who test RNA negative. Detection of anti-HCV antibodies is typically delayed for up to 12 weeks and occasionally longer after a recent infection. There are also reports of immunocompromised patients failing to mount an antibody

response for many months after infection. In a UK study of HIV-positive MSM with acute hepatitis C, 37% and 10% of patients showed no detectable antibody 3 and 9 months after the initial presentation, respectively, Kinase Inhibitor Library chemical structure while 5% remained negative after 1 year [6]. Thus, while screening antibody-negative patients for HCV RNA is not routinely recommended, it should be considered in patients at a recognized risk of a recent infection and in those with persistent, unexplained transaminase elevations. HCV-infected patients who

experience RNA clearance (either spontaneously or after antiviral therapy) will maintain detectable antibody. These patients should undergo HCV RNA screening if they show persistent unexplained transaminase elevations or have a recognized risk of reinfection. The reader is referred to the BHIVA immunization guidelines [1] for a detailed description of the indications and modalities for screening and vaccination. Testing for VZV IgG is recommended in either all patients or in those lacking PLX3397 chemical structure a reliable history of chickenpox or shingles, according to local preference [2]. VZV IgG-seronegative patients should be considered for vaccination according to their immune status [1]. HSV-2 coinfection is common in HIV-positive patients and may be accompanied by recognized genital disease or be clinically unrecognized. There is a strong epidemiological association between HSV-2 and HIV infections and bidirectional

interactions have been described that promote viral replication and infectivity. Testing for type-specific HSV antibodies is available commercially. The tests distinguish between HSV-1 and HSV-2 infections and typically become positive from 2 weeks to 3 months after the initial onset of symptoms of primary or initial infection. HSV-2 antibody positivity almost is consistent with a diagnosis of genital herpes, whereas HSV-1 antibody positivity does not differentiate between genital and nongenital infections. Guidelines on the use of HSV type-specific serological testing have recently been drafted for BASHH [7] and the International Union Against Sexually Transmitted Infections (IUSTI) [8]. Although HSV-2 seropositivity increases the risk of HIV transmission [9] and frequent HSV recurrences augment HIV replication [10, 11], there is no firm evidence to inform the management of HSV-2 coinfection in HIV-infected persons without symptoms of genital herpes. Serological HSV testing is not routinely recommended in HIV-infected persons (IV).