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Third-generation assays for hepatitis C antibodies: a four-year study of pattern changes in patients with chronic and
R Perniola1, C De Rinaldis, G Leo
1Paediatric Unit, Vito Fazzi Regional Hospital, Lecce, Italy.
Insights
Antibody levels in hepatitis C virus (HCV) infection can decrease over time, especially in resolved cases. Long-term monitoring is crucial for distinguishing chronic from past HCV infections, as single-point evaluations may be unreliable.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis C virus antibody (HCV-Ab) assays have improved, but polymerase chain reaction (PCR) remains key for diagnosing chronic infection.
- Third-generation HCV-Ab assays were used in a four-year follow-up to track antibody level trends.
Purpose of the Study:
- To determine antibody level trends in patients with current and past hepatitis C virus infections.
- To assess the utility of antibody titre changes in differentiating chronic from resolved HCV infections.
Main Methods:
- Seventy-two multitransfused subjects with confirmed HCV-Ab reactivity were followed for 41-47 months.
- Viraemia assessed using standardized PCR and nested PCR; antibody trends analyzed with the Wilcoxon signed-rank test.
Main Results:
- No significant antibody titre variation in 41 chronically infected (HCV-RNA positive) patients.
- Significant decrease in anti-c22p, anti-c33c, and anti-c100p levels observed in 19 past infected patients.
- Variable antibody trends noted in 12 patients with indeterminate PCR results.
Conclusions:
- Resolving hepatitis C is linked to decreasing antibody titres, but requires extended observation for accurate diagnosis.
- Individual patient antibody trend evaluation can be unreliable.
- Further advancements in HCV-RNA diagnostics are necessary due to occasional doubtful results.
Background:
Many advances have been made in the sensitivity of assays for hepatitis C virus antibodies (HCV-Ab). Nevertheless, polymerase chain reaction (PCR) is still the best method to establish if infection has become chronic. In this study we utilised third-generation assays for HCV-Ab in a four-year follow-up to determine the trend in antibody levels in currently and past infected patients.
Methods:
Seventy-two multitransfused subjects were enrolled. All the patients were reactive at the first test with third-generation screening and confirmatory assays (ELISA-3 and RIBA-3) for HCV-Ab. They were subsequently retested in a follow-up ranging from 41 to 47 months. Viraemia was investigated with a standardised PCR kit; negative samples were reevaluated with nested PCR. Differences in antibody trend were calculated with the Wilcoxon signed-rank test.
Results:
No statistical variation in antibody titre was found in the 41 HCV-RNA positive patients, although some of these showed a decrease in anti-c100p level. In contrast, anti-c22p, anti-c33c and anti-c100p levels decreased significantly in the 19 past infected patients. Twelve patients were HCV-RNA negative or intermittently positive with commercial PCR test, and consistently or intermittently positive in nested PCR: in these patients, antibody trend varied.
Conclusions:
Although resolving hepatitis is associated with a decrease in antibody titre, the trend should be observed for a long period to distinguish between chronic and past infection. However, the evaluation in a single patient can be unreliable. Since a doubtful response for HCV-RNA is in some cases obtained, further improvements in the diagnosis of chronic HCV infection are needed.