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HCV Core-Antigen Test Cheaper, Quicker Than RNA
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A hepatitis C virus core-antigen test was sensitive and specific in diagnosing acute infection among HIV-positive men who have sex with men, researchers reported in Clinical Infectious Diseases.
According to the researchers, the test would not have missed any infections if used in place of RNA PCR testing. The test also is significantly less costly than PCR tests and results from core-antigen testing can be available the same day, compared with up to 1 week for PCR.
“Such earlier diagnosis would enable earlier commencement of therapy if indicated for the individual, and would facilitate contact tracing and partner notification,” Fiona V. Cresswell, MD, of the Royal Sussex County Hospital in Brighton, England, and colleagues, wrote. “We argue therefore that increased use of HCV core-antigen testing in preference to [PCR testing] has potentially substantial benefits to the laboratory, clinician, patient and to public health.”
The researchers evaluated the core-antigen test on patients attending an HIV outpatient clinic and undergoing routine liver function tests, mandated every 4-6 months according to British guidelines. Individuals who had newly elevated alanine transaminase (ALT) levels between April 2012 and December 2013 were screened for HCV with core-antigen testing, PCR testing and antibody testing.
Among 2,058 patients undergoing routine blood monitoring, 111 (5.4%) had newly elevated ALT levels. Fifteen cases of acute HCV were identified by PCR testing, and core-antigen testing also identified the 15 infections, for a sensitivity of 100%. There were no false-positive core-antigen results, but there were two indeterminate results. The specificity was 97.96% (95% CI, 92.1-99.6). The positive predictive value was 88% (95% CI, 62.2-97.9); the negative predictive value was 100%.
Core-antigen testing was approximately $85 less per patient compared with PCR testing. The researchers estimated that among approximately 2,200 patients in the cohort, the potential cost savings would have been $8,160 in testing kits alone, in addition to saving 14 days of manpower.
“HCV core-antigen’s utility in low-resource settings, where PCR may be unavailable, would be even more significant,” the researchers wrote. “A larger study with further cost-analysis would be valuable.”
Disclosure: The researchers report no relevant financial disclosures.
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