1082 A PROSPECTIVE EVALUATION BY PAIRED BIOPSY OF FIBROSIS PROGESSION IN HIV-HCV COINFECTION COMPARED TO HCV MONOINFECTION

Abstract

BACKGROUND: Early detection and treatment of Hepatitis C can change the natural history of disease. AIM: The primary aim of this study was to detect infection of hepatitis C using a rapid immunochromatographic assay in a community setting. The secondary aims included assessment of prevalence rate and disease characteristics; including liver function tests, viral load, grade and stage of disease on the liver biopsy. METHODS: Two cohorts of 4000 and 3212 people (.004% of the population) were surveyed over a three week period each between December 2008 through August 2009. Qualitative detection of hepatitis C antibodies was done using a colloidal gold enhanced rapid immunochromatographic assay (Health Chem Diagnostics LLC, FL-USA).Viral load was calculated using RT PCR (Taqman) and those found positive underwent liver biopsy.28 and 33patients with proven chronic hepatitis C formed the controls for validation of the kit used in the first and the second cohort. RESULTS: 64 people were detected to have positive antibodies (0.008%) to hepatitis C (Cohort 1 -33/ 4000, Cohort 231/3212). In the first cohort, among 28 persons with positive antibodies detected with the kit, abnormal LFT were observed in 21 (75 %) and 10 (35.7 %) had more than > 2 ALT levels (Range 17174 IU/ml).24 agreed for further testing with RT PCR and another 4 agreed for testing using another method (Enzyme immunoassay).The mean viral load was 5757445 IU/ml (Range 2756345448680 IU/ml).Only one person detected to have positive antibodies with the kit was found to have negative HCV PCR. 15 patients (62.5%) who underwent liver biopsy, 9 showed evidence of advanced fibrosis (≥F2) and 7 showed moderate necroinflammation (A 2). 12 patients (50%) undertook standard treatment with Pegylated Interferon and Ribavarin and 8 of them have achieved either rapid or early virological response at the last follow up. The prevalence rate was detected to be 15 per thousand people. The second cohort is under evaluation for further assessment and management. CONCLUSION: The kit test based detection technique for hepatitis C is quite an effective strategy for early detection especially in community based setting. Further large surveillance studies are required to detect this disease for its effective control.