Diagnosis of acute hepatitis C virus infection and estimated incidence in low- and high-risk English populations

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Diagnosis of acute hepatitis C virus infection and estimated incidence in low-

and high-risk English populations

Authors: Brant, L. J.1; Ramsay, M. E.1; Balogun, M. A.1; Boxall, E.2; Hale, A.3;

Hurrelle, M.3; Kaluba, L.4; Klapper, P.5; , D.3; Patel, B. C.6; Parry, J.1;

Irving, W. L.4

Source: Journal of Viral Hepatitis, Volume 15, Number 12, December 2008 , pp.

871-877(7)

Publisher: Blackwell Publishing

Abstract:

Summary. 

The diagnosis of acute hepatitis C virus (HCV) infection is not straightforward;

few people exhibit clinical symptoms and genome/antigen detection techniques do

not indicate when infection had occurred. Here, a strategy to detect HCV RNA in

the absence of antibody (`window-period') for diagnosis of acute infection is

assessed. The sentinel surveillance of hepatitis testing study was used to

retrospectively identify anti-HCV negative samples from high-risk individuals

(2002-2003), for testing singly for HCV RNA. Additional samples were identified

prospectively (2005) and tested in pools for HCV RNA. Positive samples were

genotyped. Incidence and costs of adopting the pooling strategy were estimated.

In the retrospective study, 8/390 (2.1%) samples were confirmed HCV RNA

positive, anti-HCV negative. Prospectively, 3237 samples were tested in 325

pools. Five positive pools identified four confirmed HCV RNA positive patients

(one false positive). Estimated incidence was 12.9 per 100 person-years in

injecting drug users (IDUs) (retrospective study) and 3.7 per 100 person-years

among drug/alcohol services and prison attendees (prospective study). Estimated

costs were £850 per positive sample, in areas of higher risk. The yield from a

window-period strategy depends upon the population tested. Pooled HCV RNA

testing of anti-HCV negative samples from the current IDUs is realistic and

relatively inexpensive to identify recently infected individuals.

Keywords: acute infection; hepatitis C virus; incidence; surveillance; window

period

Document Type: Research article

DOI: 10.1111/j.1365-2893.2008.01009.x

Affiliations: 1: Department of Immunisation, Health Protection Agency, Centre

for Infections, London 2: West Midlands Public Health Laboratory, Health

Protection Agency, Heart of England Foundation Trust, Birmingham 3: Department

of Virology, Leeds General Infirmary, Old Medical School, Leeds 4: Department of

Microbiology, Queens Medical Centre, University of Nottingham, Nottingham 5:

Manchester Medical Microbiology Partnership, Manchester Royal Infirmary,

Manchester 6: HPA Collaborating Centre, North Middlesex University Hospital,

London, UK

[Guest guest]

http://www.ingentaconnect.com/content/bsc/jvh/2008/00000015/00000012/art00004;js\

essionid=berbitciulg8e.alice

Diagnosis of acute hepatitis C virus infection and estimated incidence in low-

and high-risk English populations

Authors: Brant, L. J.1; Ramsay, M. E.1; Balogun, M. A.1; Boxall, E.2; Hale, A.3;

Hurrelle, M.3; Kaluba, L.4; Klapper, P.5; , D.3; Patel, B. C.6; Parry, J.1;

Irving, W. L.4

Source: Journal of Viral Hepatitis, Volume 15, Number 12, December 2008 , pp.

871-877(7)

Publisher: Blackwell Publishing

Abstract:

Summary. 

The diagnosis of acute hepatitis C virus (HCV) infection is not straightforward;

few people exhibit clinical symptoms and genome/antigen detection techniques do

not indicate when infection had occurred. Here, a strategy to detect HCV RNA in

the absence of antibody (`window-period') for diagnosis of acute infection is

assessed. The sentinel surveillance of hepatitis testing study was used to

retrospectively identify anti-HCV negative samples from high-risk individuals

(2002-2003), for testing singly for HCV RNA. Additional samples were identified

prospectively (2005) and tested in pools for HCV RNA. Positive samples were

genotyped. Incidence and costs of adopting the pooling strategy were estimated.

In the retrospective study, 8/390 (2.1%) samples were confirmed HCV RNA

positive, anti-HCV negative. Prospectively, 3237 samples were tested in 325

pools. Five positive pools identified four confirmed HCV RNA positive patients

(one false positive). Estimated incidence was 12.9 per 100 person-years in

injecting drug users (IDUs) (retrospective study) and 3.7 per 100 person-years

among drug/alcohol services and prison attendees (prospective study). Estimated

costs were £850 per positive sample, in areas of higher risk. The yield from a

window-period strategy depends upon the population tested. Pooled HCV RNA

testing of anti-HCV negative samples from the current IDUs is realistic and

relatively inexpensive to identify recently infected individuals.

Keywords: acute infection; hepatitis C virus; incidence; surveillance; window

period

Document Type: Research article

DOI: 10.1111/j.1365-2893.2008.01009.x

Affiliations: 1: Department of Immunisation, Health Protection Agency, Centre

for Infections, London 2: West Midlands Public Health Laboratory, Health

Protection Agency, Heart of England Foundation Trust, Birmingham 3: Department

of Virology, Leeds General Infirmary, Old Medical School, Leeds 4: Department of

Microbiology, Queens Medical Centre, University of Nottingham, Nottingham 5:

Manchester Medical Microbiology Partnership, Manchester Royal Infirmary,

Manchester 6: HPA Collaborating Centre, North Middlesex University Hospital,

London, UK