Moving Toward Hepatitis C Elimination in Haemodialysis: HCV Antigen as a Practical Screening Alternative

Hepatitis C virus (HCV) screening is routinely performed in patients undergoing haemodialysis (HD) to detect incident infections. Currently, patients undergoing HD are screened using enzyme immunoassays (EIA) that detect hepatitis C antibodies (HCV Ab) before dialysis initiation and are subsequently monitored periodically. This study evaluated the diagnostic yield of HCV core antigen (HCV Ag) testing as a screening tool in a contemporary HD population at Singapore General Hospital. This single-centre, cross-sectional observational diagnostic evaluation included patients with end-stage renal failure on HD for more than six months who tested negative for HCV Ab by EIA. Participants underwent HCV Ag testing using the ARCHITECT assay, with a reactive threshold of ≥3.00 fmol/L. Repeat HCV Ab testing was performed after six months to assess for seroconversion. Of 250 recruited patients, one was excluded due to known HCV infection. Among the remaining patients, none tested positive for HCV Ag, and no false-negative HCV Ab results were identified during follow-up. The study cohort included 159 males with a median age of 63 years (IQR 14) and a mean alanine aminotransferase (ALT) of 28.1 U/L. HCV Ag testing did not identify any new HCV infections in this HD cohort, demonstrating its potential as a cost-effective and reliable alternative to periodic HCV Ab testing for routine HCV screening in this population.