HCV Core Antigen Diagnostic Performance for Acute/Recent HCV Infection in People With HIV-1: A Systematic Review and Meta-Analysis.

Background: Hepatitis C virus (HCV) core antigen (HCVcAg) has been validated to identify HCV infection, but its efficacy in diagnosing acute HCV infection among people with HIV-1 (PWH) warrants further investigation. This systematic review and meta-analysis aimed to evaluate the diagnostic performance of HCVcAg for acute or recent HCV infection among PWH. Methods: We conducted a literature search to identify studies assessing the diagnostic performance of HCVcAg from January 2020 to May 2024. Acute or recent HCV infection was defined as the presence of negative anti-HCV antibody but positive nucleic acid amplification tests (NAATs), or anti-HCV antibody seroconversion within 1 year. Studies were included if they evaluated HCVcAg diagnostic accuracy using NAATs as the gold standard and provided sufficient data for sensitivity and specificity assessment. Studies lacking a clear definition of acute or recent infection were excluded. Results: Four out of 229 articles met our inclusion criteria, with 1015 participants providing 1796 tests. The sensitivity of HCVcAg to diagnose acute or recent HCV infection ranged from 87.1% to 100% and specificity from 95.0% to 100%. The meta-analysis yielded a pooled sensitivity of 0.92 (95% CI, 0.78-0.98) and specificity of 0.99 (95% CI, 0.97-1.00). Based on the global incidence (8.46 per 1000 person-years) of HCV viremia among PWH, the positive and negative predictive values of HCVcAg were 0.44 (95% CI, 0.18-1.00) and 1.00 (95% CI, 0.99-1.00), respectively. Conclusions: HCVcAg has good diagnostic performance in identifying PWH with acute or recent HCV infection, supporting its integration into HCV screening protocols for PWH.