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Community prevalence of hepatitis C viraemia: a polymerase chain reaction study
1Institute of Liver Studies, King's College School of Medicine, London, UK.
Insights
Hepatitis C virus (HCV) carriage prevalence in an inner city was 0.7% using polymerase chain reaction (PCR) testing. Standard antibody tests are poor predictors of actual HCV RNA presence in general practice populations.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) infection is a significant public health concern.
- Estimating HCV carriage in diverse populations is crucial for targeted interventions.
- Previous studies often relied on blood donor data, potentially underestimating community prevalence.
Purpose of the Study:
- To determine the point prevalence of Hepatitis C virus (HCV) RNA carriage in an inner city health district.
- To evaluate the predictive value of anti-HCV antibody tests in a general practice setting.
- To compare HCV carriage rates with Hepatitis B virus (HBV) markers.
Main Methods:
- A polymerase chain reaction (PCR) based survey of sera from 1,002 patients attending general practitioners.
- Inclusion of 305 samples from patients previously screened for anti-HCV using C100 antigen.
- Analysis of HCV RNA, anti-HCV antibodies, ELISA optical densities, liver function tests, and HBV markers.
Main Results:
- The minimum point prevalence of HCV RNA carriage was 0.7% (7 out of 1,002 patients).
- Only 4 of the 7 PCR-positive cases had detectable anti-HCV antibodies.
- Anti-HCV antibody tests showed poor predictive value (approximately 10%) for HCV RNA carriage in this population.
Conclusions:
- HCV carriage in this inner city population is higher than predicted by blood donor surveys.
- Standard anti-HCV antibody screening is insufficient for identifying active HCV infections in general practice.
- PCR-based testing is essential for accurate HCV RNA prevalence estimation.
Abstract:
In order to estimate the prevalence of HCV carriage in an inner city health district, we undertook a polymerase chain reaction (PCR) based survey of sera collected from 1,0002 patients attending general practitioners for reasons unrelated to liver disease. The series comprised 305 sample selected sera patients sample from sera 995 patients previously screened by C100 antigen-based anti-HCV tests. Overall, 7 patients were positive for HCV RNA. Four cases had anti-C100 antibodies to HCV, 2 were strictly negative but had high-normal/borderline optical densities by ELISA assay, while one was completely anti-HCV negative. All but one had normal liver function tests. Only 3/7 PCR positive cases had any serum marker for hepatitis B (HBV) exposure (2 HBsAg positive, 1 IgM anti-HBc positive). The minimum point prevalence of HCV carriage in this community is 0.7%, approximating the HBsAg carriage in the same population (1%). HCV carriage in this inner city population is considerably higher than would be predicted by blood donor surveys. A positive anti-HCV anti-body (anti-C100) test is poorly predictive (approximately 10%) of HCV RNA carriage in a general practice based population in which measurement of "surrogate" (HBV related) HCV markers would have detected only 3/7 cases of presumed chronic HCV carriage.