Combination hepatitis C virus antigen and antibody immunoassay as a new tool for early diagnosis of infection

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Abstract
Summary. Reduction of the window period of hepatitis C virus (HCV) infection represents an important goal in the transfusional and diagnostic setting. A prototype assay designed to simultaneously detect circulating HCV antigen and anti‐HCV, has been developed. Aim of this study was to evaluate the performance of this new assay in terms of specificity and sensitivity and to compare its efficacy with commercial assays. To evaluate the specificity of the assay, 400 samples from the general population and 100 ‘difficult’ sera, negative for anti‐HCV, were tested. To assess sensitivity, the new test was used on 76 PCR‐positive and anti‐HCV negative sera, seven natural or commercial seroconversion panels that included 17 RNA‐positive and anti‐HCV negative sera and 31 anti‐HCV positive sera, 20 weak anti‐HCV positive sera, 80 viraemic and anti‐HCV‐positive sera from patients infected with different subtypes and 10 sera from patients with HBV–HCV or HIV–HCV co‐infections. Of 500 anti‐HCV negative samples, 499 (99.8%) were negative with a cut‐off index <0.5, while one sample was within the grey zone. Of the 93 HCV‐RNA positive and anti‐HCV negative sera from patients and panels, 85 (91.4%) resulted positive, and one had the cut‐off index in the grey zone. The reduction in the diagnostic window period observed with the new test and HCV‐RNA assays were equal, on average, to 24 and 34.4 days respectively. All anti‐HCV positive sera were positive. The new assay shows high sensitivity and specificity and could be a useful tool not only in the diagnostic setting, where procedures to reduce the window period, such as antigen or HCV‐RNA detection, are not currently recommended, but also in the screening of blood donations, when nucleic acid technologies is not feasible because of costs, organization, emergency and/or logistic difficulties.