Hepatitis C virus core antigen test in monitoring of dialysis patients.

Gioacchino Li Cavoli,Ugo Rotolo,Filippo Spadaro,Mario Coglitore,Onofrio Schillaci,Francesca Servillo,Carmela Zagarrigo,Concetta Scimeca,Angelo Tralongo,Natalia Li Destri

doi:10.1155/2012/832021

Abstract

Hepatitis C virus infection is a persistent worldwide public health concern. The prevalence of HCV infection is much higher in patients on chronic haemodialysis (HD) than in the general population. HCV infection can detrimentally affect patients throughout the spectrum of chronic kidney disease. Despite the control of blood products, hepatitis C virus transmission is still being observed among patients undergoing dialysis. Detection systems for serum HCV antibodies are insensitive in the acute phase because of the long serological window. Direct detection of HCV depends on PCR test but this test is not suitable for routine screening. Recent studies have highlighted the importance of HCV core antigen detection as an alternative to PCR. Few studies exist about the efficacy of HCV core antigen test in dialysis population. We studied the utility of HCV core antigen test in routine monitoring of virological status of dialysis patients. We screened 92 patients on long-term dialysis both by PCR HCV-RNA and HCV core antigen test. The sensitivity of HCVcAg test was 90%, the specificity 100%, the positive predictive power 100%, the negative predictive power 97%, and the accuracy 97%. We think serological detection of HCV core antigen may be an alternative to NAT techniques for routine monitoring of patients on chronic dialysis.

Highlights

Hepatitis C virus (HCV) infection is a persistent public health concern
Among 26 HCVAbpositive patients, 6 were both HCV core antigen (HCVcAg) negative and HCVRNA negative: 4 of these were immunoblotting negative and 2 immunoblotting positive; we considered in these 6 patients the current absence of HCV infection as in HCVAb negative subjects
HCVcAg may be an alternative to HCV-RNA detection, since no subjects, who were negative for HCVcAg, were positive for HCV-RNA in a large population-based cohort study of Ohsawa et al [20]; a recent study of Kato et al suggests that detection of HCVcAg combined with anti-HCV antibody is useful in predicting long-term survival prognosis of persistent HCV infection in HD patients [21]

Summary

Introduction

Hepatitis C virus (HCV) infection is a persistent public health concern. HCV infects approximately 170 million people worldwide [1]. The prevalence of HCV infection is much higher in patients on chronic haemodialysis (HD) than in the general population. A quantitative HCV core antigen (HCVcAg) test has been developed for the confirmation of viremia in patients with hepatitis C. This test can detect total nucleocapsid core antigen whose sequence is highly conserved across HCV genotypes. Some studies in the general population have highlighted the importance of HCVcAg detection as an alternative to NAT for early diagnosis of infection, as direct marker of viral replication in chronic phase of infection and as relevant marker for predicting and monitoring the response to therapy [8]

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