Early detection of hepatitis C virus infection by use of a new combined antigen-antibody detection assay: potential use for high-risk individuals

Hospitalizations and deaths among people coinfected with HIV and HCV

Coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) remains a significant public health challenge. This retrospective, population-based study assessed the trends in hospitalization rates among patients co-infected with HCV and HIV in Poland in 2012-2022, encompassing the COVID-19 pandemic and massive influx of war refugees from Ukraine, the demographics and clinical characteristics among hospitalized patients, including in-hospital case fatality rates. Most hospitalized patients were over 40 years old (mean ± SD: 41.7 ± 8.9 years) and were men (74%). The mean annual hospitalization rate was estimated at 1.33 per 105 and was three-fold lower in the pandemic period (mean 0.51 per 105) than in the pre-pandemic era (mean 1.63 per 105). In turn, the in-hospital case-fatality rates increased during the pandemic in men (from a mean of 1.83 to 3.93) but not in women (a mean of 1.53 in both periods). There was no significant increase in hospitalization rates in 2022, during which the significant inflow of war refugees in Ukraine occurred. The epidemiological situation of people (co)infected with HIV and HCV in Poland requires further monitoring, though it did not escalate in the studied period due to the influx of war refugees from Ukraine.

Management of in- and out-of-hospital screening for hepatitis C

Because of insidious progression and no significant clinical symptoms at early stage, chronic hepatitis C (CHC) is often diagnosed after the occurrence of cirrhosis and hepatocellular carcinoma. Highly effective and low drug resistance of direct-acting antiviral agents (DAAs) have enabled cure of CHC, encouraging the World Health Organization to propose a global viral hepatitis elimination program. To Date, vaccine for CHC is still under research. Therefore, reducing the source of infection is an important means of eliminating CHC other than cutting off the transmission route, which requires screening, diagnosing and treating as many patients in the population as possible. Hospital-based screening strategy have been found to be cost-effective in the management of CHC screening, as reported both nationally and internationally. Currently, China has issued In-hospital process for viral hepatitis C screening and management in China (Draft) in April, 2021, which provides a standardized implementation process and direction for in-hospital hepatitis C screening and treatment, but still requires medical institution to develop its own management process, taking into account its current situation and learning from domestic and international experience. In addition, screening for CHC outside the hospital among special populations, such as blood donors, pregnant women, homosexuals, intravenous drug users, prisoners, and residents in rural areas with scarce medical care resources, also requires attention and development of targeted and rational screening strategies. In this paper, we analyze and recommend the management of hepatitis C screening from both in-hospital and out-of-hospital perspectives, with the aim of contributing to the formulation of hepatitis C screening strategies.

Multicenter performance evaluation of the Elecsys HCV Duo immunoassay

BACKGROUND

The diagnostic accuracy of the Elecsys® HCV Duo antigen-antibody combination immunoassay (Roche Diagnostics GmbH) was evaluated for the detection of hepatitis C virus (HCV) infection, versus commercially available comparators.

METHODS

This multicenter study (August 2020-March 2021) assessed the specificity of the Elecsys HCV Duo immunoassay and comparator assays in blood donor and routine clinical laboratory samples; sensitivity was determined in confirmed HCV-positive samples and seroconversion panels. The Elecsys HCV Duo immunoassay was compared with the Monolisa HCV Ag-Ab ULTRA V2, Murex HCV Ag/Ab Combination and ARCHITECT HCV Ag assays, as well as nucleic acid testing (NAT). The antibody (anti-HCV) module of the Elecsys HCV Duo immunoassay was compared with the Elecsys Anti-HCV II, Alinity s Anti-HCV, ARCHITECT Anti-HCV and RIBA HCV 3.0 SIA assays.

RESULTS

The specificity of the Elecsys HCV Duo immunoassay was 99.94% (95% confidence interval [CI], 99.89-99.97) and 99.92% (95% CI, 99.71-99.99) in blood donor (n = 20,634) and routine clinical laboratory samples (n = 2531), respectively. The specificity of the Elecsys HCV Duo immunoassay was similar or better than comparator assays. The sensitivity of the Elecsys HCV Duo immunoassay in confirmed HCV-positive samples (n = 257) was 99.6%. In seroconversion panels, the Elecsys HCV Duo immunoassay detected infections earlier (2.2-21.9 days) than all but one of the comparator assays and detected HCV 1.8 days later than NAT.

CONCLUSIONS

The Elecsys HCV Duo immunoassay shows high diagnostic accuracy, reduces the diagnostic window, and could be used when NAT is not possible.

RT-LAMP-Based Molecular Diagnostic Set-Up for Rapid Hepatitis C Virus Testing

Hepatitis C virus (HCV) infections occur in approximately 3% of the world population. The development of an enhanced and extensive-scale screening is required to accomplish the World Health Organization's (WHO) goal of eliminating HCV as a public health problem by 2030. However, standard testing methods are time-consuming, expensive, and challenging to deploy in remote and underdeveloped areas. Therefore, a cost-effective, rapid, and accurate point-of-care (POC) diagnostic test is needed to properly manage the disease and reduce the economic burden caused by high case numbers. Herein, we present a fully automated reverse-transcription loop-mediated isothermal amplification (RT-LAMP)-based molecular diagnostic set-up for rapid HCV detection. The set-up consists of an automated disposable microfluidic chip, a small surface heater, and a reusable magnetic actuation platform. The microfluidic chip contains multiple chambers in which the plasma sample is processed. The system utilizes SYBR green dye to detect the amplification product with the naked eye. The efficiency of the microfluidic chip was tested with human plasma samples spiked with HCV virions, and the limit of detection observed was 500 virions/mL within 45 min. The entire virus detection process was executed inside a uniquely designed, inexpensive, disposable, and self-driven microfluidic chip with high sensitivity and specificity.

Economic Evaluation of Implementing a Rapid Point-of-Care Screening Test for the Identification of Hepatitis C Virus under National Viral Hepatitis Control Programme in Tamil Nadu, South India

Introduction:

Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis.

Methods:

To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis.

Results:

When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy.

Conclusions:

The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.

Developments in the HCV Screening Technologies Based on the Detection of Antigens and Antibodies

Hepatitis C virus (HCV) accounts for 15%-20% of cases of acute infection, and chronic HCV infection is developed in about 50%-80% of HCV patients. Unfortunately, due to the lack of proper medical care, difficulty in screening for HCV infection, and lack of awareness resulted in chronic HCV infection in 71 million people on a global scale, and about 399,000 deaths in 2016. It is crucial to recognize that the effective use of antiviral medicines can cure more than 95% of HCV infected people. The Global Health Sector Strategy (GHSS) aim is to reduce the new HCV infections and the HCV associated mortality by 90% and 65%, respectively. Therefore, the methods that are simple, yet powerful enough to detect HCV infections with high sensitivity, specificity, and a shorter window period are crucial to restrain the global burden of HCV healthcare. This article focuses on the technologies used for the detection of HCV in clinical specimens.

The future of viral hepatitis testing: innovations in testing technologies and approaches

A large burden of undiagnosed hepatitis virus cases remains globally. Despite the 257 million people living with chronic hepatitis B virus infection, and 71 million with chronic viraemic HCV infection, most people with hepatitis remain unaware of their infection. Advances in rapid detection technology have created new opportunities for enhancing access to testing and care, as well as monitoring of treatment. This article examines a range of other technological innovations that can be leveraged to provide more affordable and simplified approaches to testing for HBV and HCV infection and monitoring of treatment response. These include improved access to testing through alternative sampling methods (use of dried blood spots, oral fluids, self-testing) and combination rapid diagnostic tests for detection of HIV, HBV and HCV infection; more affordable options for confirmation of virological infection (HBV DNA and HCV RNA) such as point-of-care molecular assays, HCV core antigen and multi-disease polyvalent molecular platforms that make use of existing centralised laboratory based or decentralised TB and HIV instrumentation for viral hepatitis testing; and finally health system improvements such as integration of laboratory services for procurement and sample transportation and enhanced data connectivity to support quality assurance and supply chain management.

Ultra-sensitive aptasensor based on a GQD nanocomposite for detection of hepatitis C virus core antigen

In the present study, by using the aptamer proximity binding assay strategy, a novel electrochemical aptasensor is described for ultrasensitive detection of hepatitis C virus (HCV) core antigen. The immobilization surface is prepared by the modification of a glassy carbon electrode (GCE) with a graphene quantum dots (GQD). GQD were introduced as a novel and suitable substrate for aptamers through π-π stacking interactions, the richness of hydrophilic edges as well as hydrophobic plane in GQD which enhances the aptamer absorption on the electrode surface. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) and differential pulse voltammetry (DPV) were performed at each stage of the chemical modification process to confirm the resulting surface changes. EIS technique was used as an efficient alternative detection system for HCV core antigen measurement with detection limit 3.3 pg mL^-1 and two linear concentration range 10-70 pg mL^-1 and 70-400 pg mL^-1. Moreover, the fabricated aptasensor could accurately detect HCV core antigen concentration in human serum samples. Such an aptasensor opens a rapid, selective and sensitive route for HCV core antigen detection and provides a promising strategy for potential applications in clinical diagnostics.

Replicon Particle Expressing the E2 Glycoprotein of Bovine Viral Diarrhea Virus Immunization and Evaluation of Antibody Response

The objective of this study was to develop a new antigen delivery system using an alphavirus replicon particle (RP) to induce humoral antibody responses against bovine viral diarrhea virus (BVDV) recombinant antigen produced from envelope glycoprotein E2. An alphavirus RP expressing the E2 glycoprotein of BVDV was used for immunization of pigs. A fluorescent microsphere immunoassay (FMIA) has been applied to detect BVDV E2 antigen-specific antibody isotype in pig immunized with alphavirus RP. Full-length BVDV E2 (aa 1-375) was cleaved into several pieces, eight E2 DNA fragments, including full-length DNA, were cloned into expression vector pHUE, and the recombinant proteins expressed in BL-21 (DE3) Escherichia coli. After successful conjugation of purified proteins with microsphere beads, a multiplex FMIA platform was constructed, and BVDV E2 alphavirus-based RP-immunized animal serum samples were tested in the presence of bead-bound antigen targets. The results were represented as mean fluorescence intensity (MFI); the MFI values were converted to sample value/positive value (S/P) ratios. BVDV E2 (aa 1-183) showed the highest MFI values of eight recombinant E2 fragments when the specific activity of each fragment was tested. In immunized animals, data for BVDV E2-specific IgA, IgG, and IgM in serum and only IgG and IgA in oral fluids were recorded. The MFI values for the positive serum sample showed a 100-fold increase compared with the negative serum sample. Antibody isotype to BVDV E2 antigens showed that IgG > IgM > IgA in serum, whereas IgG > IgA > IgM in oral fluids. The data presented in this study suggested that boosting with the same doses of alphavirus RP in 3-week intervals may potentially enhance antibody response. The experimental results demonstrate that alphavirus RP-expressing BVDV E2 antigen induces antibody response in pig.

Evaluation of an antigen-antibody "combination" enzyme linked immunosorbent assay for diagnosis of hepatitis C virus infections

Background

Development of “combination” assays detecting in parallel, within a single test, Hepatitis C Virus (HCV) antigens and antibodies, not only reduces the window period in HCV-infection but also costs. Reduction of costs is important for developing countries where money and personal resources are limited.

Methods

We compared the Monolisa® HCV Antigen-Antibody Ultra (Bio-Rad Laboratories Limited, Marnes La Coquette, France) with the AXSYM HCV version 3.0 (Abbot Diagnostics, Germany)-the latter assay detecting only antibodies to HCV. Seventy three HCV-PCR positive and negative samples were tested.

Results

Although the two assays showed comparable results, two samples from a bone marrow transplant (BMT) patient of viral loads 7.8 × 10₅ and 8.9 × 10₆ IU/mL could not be detected by the Monolisa® HCV Antigen-Antibody Ultra assay. Failure to detect the two samples with viral loads considered above threshold of detection for antigen proteins suggested a lack of sensitivity by this assay to discover viral capsid protein in patient samples. Genotyping of these samples revealed genotype 1b, a HCV-subtype which is widespread and should thus be easily detected.

Conclusion

We conclude that although this assay depicts high sensitivity and specificity in detecting antibodies to HCV, it seems not to add further benefit in our study population to detect HCV infections by enhanced sensitivity due the potential contingency to trace viral capsid antigens.

Sensitivity of hepatitis C virus core antigen and antibody combination assays in a global panel of window period samples

BACKGROUND

Hepatitis C virus (HCV) antigen and antibody combination assays have been launched as a cost-effective alternative to nucleic acid testing (NAT) for reducing the antibody-negative window period (WP). Later, a HCV antigen chemiluminescence immunoassay (CLIA) became available.

STUDY DESIGN AND METHODS

A panel composed of 337 HCV NAT-yield samples that were characterized for viral load (VL) and genotype was used to compare the sensitivity of two combination enzyme-linked immunosorbent assays (Monolisa, Bio-Rad; and Murex, formerly Abbott) and a HCV antigen CLIA (Abbott). Analytic sensitivity was compared with HCV RNA detection using Ultrio (Grifols) by testing serial dilutions of 10 genotype (gt)1 to gt4 samples.

RESULTS

HCV antigen CLIA detected 92.4% of samples, whereas Monolisa and Murex detected 38.3 and 47.5%, respectively. In the HCV RNA VL range of 10(5) to 10(7) IU/mL, Monolisa and Murex detected 38% to 56% of gt1, 85% to 78% of gt2, and 21% to 37% of gt3. The overall geometric mean 50% limit of detection (range) of Ultrio on gt1 to gt4 dilution series was 3.5 (1.2-7.7) copies/mL, compared to 3.3 × 10(6) (4.4 × 10(5) -2.7 × 10(7) ), 3.4 × 10(6) (2.2 × 10(5) -4.2 × 10(7) ), and 2728 (415-7243) copies/mL for Monolisa, Murex, and HCV antigen CLIA, respectively.

CONCLUSION

Analytical sensitivity of NAT was on average 1 million- and 780-fold higher than combination assays and HCV antigen CLIA, respectively. Relative sensitivities of combination assays differed for genotypes with Murex being more sensitive for gt1 and gt3 and Monolisa more sensitive for gt2. Although being less sensitive than NAT, combination assays could be considered in resource-limited settings since they detect 38% to 47% of seronegative WP donations.

Usefulness of a fourth generation ELISA assay for the reliable identification of HCV infection in HIV-positive adults from Gabon (Central Africa)

Background/Objectives

Guidelines for optimized HCV screening are urgently required in Africa, especially for patients infected with HIV, who sometimes show false positive or false negative reactivity in anti-HCV antibody assays. Here, we assessed the usefulness of a fourth-generation HCV Ag-Ab ELISA for the identification of active HCV infection in HIV-positive patients.

Methods

This cross-sectional study was conducted between 03/2010 and 01/2013 and included 762 Gabonese HIV-positive adult patients. The results of ELISA (Monolisa HCV Ag-Ab ULTRA, Bio-Rad) were compared with those obtained by RT-PCR (gold standard). The optimal ELISA signal-to-cutoff (S/CO) ratio to identify patients with active hepatitis C (positive HCV RNA) was determined. Specimens were further tested by the INNO-LIA HCV Score assay (Innogenetics) and the Architect HCV Ag kit (Abbott) to define the best diagnostic strategy.

Results

Sixty-seven patients tested positive for HCV (S/CO ratio ≥ 1) by ELISA. Of these, 47 (70.1%) tested positive for HCV RNA. The optimal S/CO associated with active HCV infection was 1.7. At this threshold, the sensitivity of ELISA was 97.9% (95% confidence interval (CI) 90.0–99.9%), its specificity was 91.3% (95% CI 85.0–95.5%), and HCV seroprevalence rate was 7.3% (56/762) (95% CI 5.6–9.4%). Among 57 HCV-seropositive patients with available INNO-LIA results, false reactivity was identified in 14 (24.6%), resolved HCV infection in two (3.5%), possible acute HCV infections in nine (15.8%) and likely chronic HCV infections in 32 (56.1%) patients. HCV core Ag was undetectable in 14/15 (93.3%) specimens that tested negative for HCV RNA whereas it was quantified in 34 (out of 39, 87.2%) samples that tested positive for HCV RNA.

Conclusions

Our study provides comprehensive guidance for HCV testing in Gabon, and will help greatly clinicians to improve case definitions for both the notification and surveillance of HCV in patients co-infected with HIV.

Diagnostic tests for hepatitis C: Recent trends in electrochemical immunosensor and genosensor analysis

Hepatitis C is a liver disease that is transmitted through contact with the blood of an infected person. An estimated 150 million individuals worldwide have been chronically infected with the hepatitis C virus (HCV). Hepatitis C shows significant genetic variation in the global population, due to the high rate of viral RNA mutation. There are six variants of the virus (HCV genotypes 1, 2, 3, 4, 5, and 6), with 15 recorded subtypes that vary in prevalence across different regions of the world. A variety of devices are used to diagnose hepatitis C, including HCV antibody test, HCV viral load test, HCV genotype test and liver biopsy. Rapid, inexpensive, sensitive, and robust analytical devices are therefore essential for effective diagnosis and monitoring of disease treatment. This review provides an overview of current electrochemical immunosensor and genosensor technologies employed in HCV detection. There are a limited number of publications showing electrochemical biosensors being used for the detection of HCV. Due to their simplicity, specificity, and reliability, electrochemical biosensor devices have potential clinical applications in several viral infections.

Cellular activation and intracellular HCV load in peripheral blood monocytes isolated from HCV monoinfected and HIV-HCV coinfected patients

BACKGROUND

During HCV infection, the activation status of peripheral blood monocytes and its impact on HCV replication are poorly understood. We hypothesized that a modified activation of peripheral blood monocytes in HIV-HCV coinfected compared to HCV monoinfected patients may contribute to different monocytes reservoirs of HCV replication.

METHODS

We performed a case-control analysis involving HCV-infected patients with and without HIV coinfection. In peripheral blood mononuclear cells (PBMCs), peripheral blood lymphocytes (PBLs) and peripheral blood monocytes isolated from HCV monoinfected and HIV-HCV coinfected patients, intracellular HCV load and a marker of cellular activation, nuclear factor-kappaB (NF-κB) activation, were quantified using intracellular detection of HCV-core protein and electrophoretic mobility shift assay, respectively.

RESULTS

Intracellular HCV loads were higher in monocytes isolated from HIV-HCV coinfected patients than in those of monoinfected patients. Among PBMCs isolated from HIV-HCV coinfected patients, intracellular HCV loads were higher in monocytes compared to PBLs. Cellular activation as measured by NF-κB activation was higher in monocytes isolated from HIV-HCV coinfected patients than in those of monoinfected patients.

CONCLUSIONS

Our results reveal the peripheral blood monocytes as an important extrahepatic reservoir for HCV in HIV-HCV coinfected patients and indicate a potential association between the activation state of monocytes and the size of the HCV reservoir in HIV-HCV coinfected patients.

Screening for hepatitis C virus infection in a high prevalence country by an antigen/antibody combination assay versus a rapid test

In low-income-countries, screening for hepatitis C virus (HCV) infection is often based on rapid tests (RT). Their lower sensitivity compared to enzyme immunoassay (EIA) suggests that newer HCV Antigen/Antibody (Ag/Ab) combination assays might have a role in such countries. To test this idea, 1998 blood donors were tested at the University Teaching Hospital blood bank in Yaoundé, Cameroon simultaneously with a RT (HCV rapid test, Human Diagnostics, Berlin, Germany) according to standard practice (S1) and with an Ag/Ab assay (Monolisa HCV Ag/Ab Ultra, Biorad, France) (S2). All discordant, borderline and reactive samples were submitted to confirmatory testing by immunoblot and/or HCV-RNA. Of the 86 (4.3%) samples positive with one or both strategies, 29 were confirmed negative, 37 positive and 20 were false positive or resolved infection. There was a significant difference in test sensitivity (p=0.01) between S1 (70.3%) and S2 (91.9%) but not in test specificity (99.4% and 98.6%, respectively). The benefit of the Ag/Ab assay in the detection of recent HCV seronegative infections could not be evaluated since no Antigen-only donations were identified. However, better Ag/Ab test sensitivity compared to RT supports the implementation of these newer immunoassays for HCV screening in the African blood bank setting.

Case definitions for acute hepatitis C virus infection: a systematic review

BACKGROUND & AIMS

Case definitions for recent hepatitis C virus (HCV) infection vary considerably between studies. The aim of this systematic review was to characterize case definitions for recent HCV and explore the heterogeneity in studies performed to date.

METHODS

A systematic literature search of MEDLINE, SCOPUS, and ISI Web of Knowledge was performed covering all studies of recent HCV infection cited between January 2000 and June 2011. The criteria used by each study to define cases of recent HCV infection were extracted, structured, and analyzed.

RESULTS

Overall, 195 articles were included, with 87% (n=169) providing a clear case definition for recent HCV infection. The most frequently used individual criteria for defining a case included HCV antibody seroconversion (77%), alanine aminotransferase (ALT) elevation (68%), and HCV RNA detection (63%). In studies using HCV antibody seroconversion, the window period between the last negative and the first positive antibody test varied widely across studies (4 weeks to 4 years). Considerable diversity was also observed with respect to the ALT threshold used to characterize ALT elevations, ranging from 2 to 20 times the upper limit of normal. HCV antibody seroconversion was used as a single criterion in 41% of the studies, while all other studies used at least two criteria (range: 2-9). Epidemiology/surveillance studies mostly used a more sensitive case definition, whereas treatment studies, natural history studies, and diagnosis studies used more specific case definitions.

CONCLUSIONS

Marked heterogeneity in case definitions for recent HCV infection was observed. Although a single case definition for recent HCV is not warranted, a degree of standardization within specific study categories would enable improved cross-study comparison and more uniform evaluation of HCV prevention and management strategies.

Core antigen tests for hepatitis C virus: a meta-analysis

Diagnosis and monitoring of hepatitis C virus (HCV) infection relies mainly on the detection of HCV antibodies and HCV RNA. HCV antibody test has a longer window period and is not applicable in the immunosuppressed population. Although HCV RNA test reduces the window period, it is still not widely recommended because of its high cost and requirement of specific equipment. HCV core antigen is another direct virological marker which has been investigated in recent years. HCV core antigen assay is as simple as the HCV antibodies assay and can detect HCV infection only 1 day delay compared to the HCV RNA assay. In order to evaluate the application of HCV core antigen test in HCV diagnosis and management, we performed this meta-analysis. Twenty five articles were finally included in meta-analysis. All statistical analyses were performed with MetaDisc 1.4 and Stata 11.0. The pooled sensitivity of HCV core antigen assay was 0.84 (95 % CI, 0.83-0.85), and the pooled specificity was 0.98 (95 % CI, 0.97-0.98). HCV core antigen assays may not displace HCV RNA assays to be a definitive diagnosis of HCV infection until now. Considering the higher sensitivity (0.926) and specificity (0.991) of subgroup, HCV-cAg detection is a promising method as a confirmatory test for HCV antibody positive, therapy-naive individuals. Explored by meta-regression and subgroup analysis, possible sources of heterogeneity of specificity was found, while the heterogeneity of sensitivity was still significant.

Comparison of monolisa HCV Ag/Ab ULTRA with two anti-HCV assays for the detection of HCV infection in hospital setting

In this study, we compared the performance of three serological assays (Monolisa HCV Ag/Ab ULTRA, Innotest HCV Ab IV enzyme immunoassay--EIA, and Ortho HCV 3.0 enzyme-linked immunosorbent assay--ELISA) for the detection of HCV infection. Ninety plasma samples were collected, representing 63 samples from groups at risk for acquiring HCV infection and 27 HCV RNA-positive samples. The results of Ortho HCV 3.0 ELISA, Innotest HCV Ab IV, and Monolisa HCV Ag/Ab ULTRA were fully concordant for 27 HCV RNA-positive samples. Ortho HCV 3.0 ELISA test and Innotest HCV Ab IV also gave the same results for risk groups, while three samples were found to be reactive by Monolisa HCV Ag/Ab ULTRA and were consequently found negative for HCV RNA. As two of the solely Monolisa HCV Ag/Ab ULTRA-positive samples were also hepatitis B s antigen (HBsAg)-positive, neutralization of HBsAg was performed but no arguments for the HBsAg interference were observed. In conclusion, the non-specific reactive signal was observed, in three samples using Monolisa HCV Ag/Ab ULTRA, to be negative by other serological assays, and observed to be negative in an HCV RNA assessment, a result that could not be attributed to the interference with HBsAg. In the context of diagnostic testing, no test for various HCV genotypes was observed to be superior to any other.

Evaluation of the use of a combined HCV antigen/antibody assay in routine laboratory practice

BACKGROUND

Combined hepatitis C virus (HCV) antigen/antibody (Ag/Ab) assays offer the advantage of a shorter window phase compared to traditional anti-HCV antibody assays. These assays have been extensively evaluated for the screening of healthy blood donors, but not in routine laboratory practice.

METHODS

We evaluated the performance of the combined HCV Ag/Ab assay Monolisa Ultra and compared it to Monolisa anti-HCV Plus (which only detects anti-HCV antibodies) in 61 HCV RNA-positive patients (genotypes 1 to 5) and in 276 consecutive AxSYM HCV-reactive patients. Discordant sera were tested with immunoblot and PCR.

RESULTS

All 61 PCR-positive sera were positive with AxSYM, Monolisa Ultra, and Monolisa Plus. Of the 276 consecutive AxSYM-reactive patients, 177 were confirmed as HCV-positive, 78 were HCV-negative and 21 were HCV-indeterminate. There were 4 false-positive results with Monolisa Ultra compared to 1 false-positive result with Monolisa PLus. The signal/cut-off ratio in immunoblot-negative sera was significantly higher with HCV Ultra compared to HCV Plus (p < 0.01). Sensitivity and specificity in AxSYM-reactive sera were 99.4% and 94.9% for Monolisa Ultra and 99.4% and 98.7% for Monolisa Plus.

CONCLUSION

When used as a secondary test, the sensitivity of the combined HCV Ag/Ab assay Monolisa Ultra was excellent, but specificity was reduced in AxSYM-reactive sera compared to Monolisa Plus.

Acute hepatitis C in HIV-infected patients: rare spontaneous clearance correlates with weak memory CD4 T-cell responses to hepatitis C virus

OBJECTIVES

To explore the parameters of specific immunity to hepatitis C virus (HCV) associated with virus clearance during acute HCV infection in HIV coinfection.

METHODS

HIV-infected patients without prior HCV infection were prospectively enrolled for acute hepatitis C and followed up over 15 months. HCV-specific T cells were assessed by proliferation, ELISpot, intracellular cytokine staining and pentamer assays. Pegylated-interferon-alpha and ribavirin were proposed if HCV persisted at M3.

RESULTS

Thirty eight acutely HCV-infected HIV-positive patients were enrolled. HCV genotypes were predominantly 4 and 1. Five patients (13%) showed spontaneous clearance and 20 initiated treatment, of whom 13 (65%) showed sustained virologic responses. Before M3, HCV-specific proliferative responses observed in 35% cases, were associated with lower HCV viral load (P = 0.04) and predictive of spontaneous clearance (P = 0.02), particularly anti-NS4 responses (P = 0.03). These HCV-specific proliferative responses were associated with HIV-p24-specific responses (P = 0.002) independently from the HIV stage. Interferon-gamma-producing T cells specific for HCV were detectable ex vivo in 81% cases but at low intensity (<150 spot forming cells/10 peripheral blood mononuclear cells) and were independent of the HCV outcome. Low frequencies of pentamer-positive HCV-specific CD8 cells (0.01-0.05%) detected in nine of 12 patients were mainly effector-memory PD-1-negative T cells. Twelve days of HCV-specific in-vitro culture induced amplification of CD4 T cells coproducing interleukin-2 and interferon-gamma but rarely of CD8 T cells.

CONCLUSION

Acute HCV infection in HIV-coinfected patients is characterized by a low rate of spontaneous clearance and weak HCV-specific memory T cells, not strictly related to HIV-induced immune defects, and which correlate with virus clearance.

Delayed anti-HCV antibody response in HIV-positive men acutely infected with HCV

OBJECTIVE

An epidemic of acute hepatitis C virus (HCV) infection among HIV-positive men who have sex with men is occurring in urban centers in Western Europe and the United States. Early diagnosis and treatment of HCV results in improved sustained virological response rates. This study compared the sensitivity of reverse transcriptase PCR (RT-PCR) versus antibody screening for the diagnosis of early HCV infection in HIV-positive patients and estimated the length of time from HCV infection to the development of anti-HCV antibodies.

DESIGN

Patients from the St Mary's Acute Hepatitis C Cohort (SMACC) were recruited retrospectively and prospectively between 2004 and 2008.

METHODS

Archived plasma samples, obtained at 1-3 monthly intervals for routine monitoring of HIV viral load were assayed retrospectively for HCV in order to assess the sensitivity of RT-PCR and enzyme-linked immunosorbent assay (ELISA).

RESULTS

: Forty-three HIV-positive patients with early HCV infection were identified. The median CD4 cell count was 570 cells/microl. The median alanine transaminase at the time of the first positive HCV PCR was 65 IU/ml. At this time, 75% of patients had a negative HCV antibody test. Three months later, 37% of patients still had a negative result. After 9 months, 10% of patients had a negative test and 5% remained negative after 1 year.

CONCLUSION/DISCUSSION

Delayed seroconversion in HIV-positive individuals with acute HCV may result in delayed diagnosis and treatment. Where there is a clinical suspicion of recent HCV infection, for example, elevated alanine transaminase levels, HIV-infected patients should be screened for HCV RNA by RT-PCR.

Simultaneous detection of anti-HCV antibody and HCV core antigen

HCV infection is usually diagnosed by means of an enzyme immune assay for the detection of antibody against HCV. The window period between infection and seroconversion remains a dramatic problem in the transfusional and diagnostic setting. In this chapter, we report (i) procedures for assays using two different approaches designed to reduce the window period and (ii) performance in terms of specificity and sensitivity in the detection of both antibody and antigen, and we compare their efficacy with that of commercial assays.

Diagnosing acute hepatitis C in HIV-infected patients: nucleic acid testing compared with antibody and antigen-antibody detecting methods

BACKGROUND

Early diagnosis of hepatitis C virus (HCV) infection in HIV-infected patients has significant implications for patient management. However, the currently recommended serological screening strategy for identifying such patients could be improved. Little is known about the performance of routine antibody-only tests, compared with newer serological antigen-antibody detection assays and nucleic acid testing in this patient group.

OBJECTIVES

To compare the performance of antibody and antigen-antibody detecting methods with nucleic acid testing in the diagnosis of acute HCV in HIV-infected individuals.

STUDY DESIGN

123 samples from 25 HIV-infected patients with acute HCV infection were tested retrospectively. The time of infection was estimated. The performance of antibody, antigen-antibody and nucleic acid detecting methods in diagnosing acute HCV infection was assessed and the sensitivity of the assays compared.

RESULTS

Only 20% of samples that were positive for HCV RNA were simultaneously positive for HCV antibody. In contrast, 68% of the total number of samples were positive and 32% negative by the antigen-antibody assay. Patients became antibody-positive on average 7 months after HCV RNA was detected.

CONCLUSION

In HIV-infected patients nucleic acid testing is the most sensitive means of diagnosing acute HCV C infection. A serological assay offering combined detection of antibody and antigen enhances sensitivity of detection, compared to antibody-only assays.

Simultaneous detection of hepatitis C virus core antigen and antibodies in Saudi drug users using a novel assay

Drug users and particularly, injecting drug users, are at increased risk for infection with hepatitis C virus (HCV). The aims of the study were to simultaneously detect HCV core antigen and specific antibodies in sera from Saudi drug users using the new HCV combination assay and to compare this data with HCV core antigen, anti-HCV antibodies and HCV RNA data from the same patients. A total of 297 patients who are followed up or admitted to a drug rehabilitation hospital over a period of 3 years were included in this study. Samples were analyzed using the new HCV Ag/Ab combination assay (Meurex), HCV core Ag assay, HCV antibodies and with the HCV RNA assay. Out of the 297 samples from Saudi drug users, 111 samples (37.4%) have detectable HCV core Ag, 112 samples (37.7%) have detectable HCV antibodies, 118 have detectable HCV RNA, and 116 samples were positive by the HCV Ag/Ab combination assay (39.1%). Out of the 116 samples, HCV core Ag was detected in 110 samples (94.8%), HCV antibodies were detected in 111 (95.7%) samples and HCV RNA was detected in 114 samples (98.3%). In the control group (n = 305), only 2 (0.66%) blood donor were positive by HCV antibodies assay, HCV RNA assay as well as HCV Ag/Ab combination assay. The new HCV Ag/Ab combination assay may well improve the overall quality of diagnosis of HCV infection especially in high risk population such as drug users that necessitates rigorous testing.

[Clinical assessment of Monolisa HCV Ag-Ab ULTRA (Bio-Rad) in a general hospital]

INTRODUCTION

To evaluate a new test based on simultaneous detection of HCV antibodies and antigen (Monolisa HCV Ag/Ab ULTRA; Bio-Rad, Marnes la Coquette, France).

METHODS

We studied samples from two groups of patients and 7 commercial HCV seroconversion panels (75 samples). Group 1: 1360 serum samples from patients referred for routine testing of anti HCV antibodies. Group 2: 333 serum samples from 183 hemodialysis patients. All samples were tested by the Ortho HCV 3.0 technique (Ortho-Clinical Diagnostics, Amersham, UK) and the Monolisa HCV Ag-Ab ULTRA technique.

RESULTS

Group 1: Seventy-four of 1360 serum samples were positive by Ortho HCV and 77 by Monolisa. In 1353 samples, the results with the two tests were concordant: 1281 negative and 72 positive. Five samples were positive only by Monolisa and 2 only by Ortho (overall agreement: 99.5%). Group 2: Results were concordant in 325 samples, 308 negative and 17 positive. Seven samples were positive by Monolisa and negative by Ortho. The sensitivity of the Monolisa test in hemodialysis patients was clearly higher than that of the Ortho test (100% and 70.8%, respectively). Monolisa detected HCV infection in 43 of 75 samples from the seroconversion panels; only 18 positive samples were detected by Ortho HCV. Monolisa reduced the window period by up to 72 days.

CONCLUSIONS

Our data indicate high agreement between the Monolisa and Ortho tests in samples from the general population. In hemodialysis patients, however, Monolisa was more sensitive. In addition, the Monolisa test significantly reduced the window period of HCV infection.

Combined hepatitis C virus (HCV) antigen-antibody detection assay does not improve diagnosis for seronegative individuals with occult HCV infection

A combined hepatitis C virus (HCV) antigen-antibody assay was evaluated for 115 seronegative individuals with occult HCV infection. The assay was reactive in one patient and negative to weakly reactive in three others (all four gave indeterminate results by supplemental assay) but failed to detect HCV in the remaining patients. Despite increased sensitivity the combined assay does not improve serodiagnosis of occult HCV infection.