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A Journal on Internal Medicine

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Panminerva Medica 1999 December;41(4):291-4

language: English

Third-gen­er­a­tion ­assays for hep­a­titis C anti­bod­ies: a four-year study of pat­tern chang­es in ­patients with chron­ic and past infec­tion

Perniola R., De Rinaldis C., Leo G.*

From the Paediatric Unit and * Laboratory Medicine Unit, Vito Fazzi Regional Hospital Lecce, Italy


Background. Many ­advances ­have ­been ­made in the sen­si­tivity of ­assays for hep­a­titis C ­virus anti­bodies (HCV-Ab). Nevertheless, poly­me­rase ­chain reac­tion (PCR) is ­still the ­best ­method to estab­lish if infec­tion has ­become ­chronic. In ­this ­study we util­ised ­third-gen­er­a­tion ­assays for HCV-Ab in a ­four-­year ­follow-up to deter­mine the ­trend in anti­body ­levels in cur­rently and ­past ­infected ­patients.
Methods. Seventy-two mul­ti­trans­fused sub­jects ­were ­enrolled. All the ­patients ­were reac­tive at the ­first ­test ­with ­third-gen­er­a­tion ­screening and con­fir­ma­tory ­assays (ELISA-3 and ­RIBA-3) for HCV-Ab. They ­were sub­se­quently ­retested in a ­follow-up ­ranging ­from 41 to 47 ­months. Viraemia was inves­ti­gated ­with a stan­dar­dised PCR kit; neg­a­tive sam­ples ­were reeval­u­ated ­with ­nested PCR. Differences in anti­body ­trend ­were cal­cu­lated ­with the Wilcoxon ­signed-­rank ­test.
Results. No sta­tis­tical vari­a­tion in anti­body ­titre was ­found in the 41 HCV-RNA pos­i­tive ­patients, ­although ­some of ­these ­showed a ­decrease in ­anti-c100p ­level. In con­trast, ­anti-c22p, ­anti-c33c and ­anti-c100p ­levels ­decreased sig­nif­i­cantly in the 19 ­past ­infected ­patients. Twelve ­patients ­were HCV-RNA neg­a­tive or inter­mit­tently pos­i­tive ­with com­mer­cial PCR ­test, and con­sis­tently or inter­mit­tently pos­i­tive in ­nested PCR: in ­these ­patients, anti­body ­trend ­varied.
Conclusions. Although ­resolving hep­a­titis is asso­ciated ­with a ­decrease in anti­body ­titre, the ­trend ­should be ­observed for a ­long ­period to dis­tin­guish ­between ­chronic and ­past infec­tion. However, the eval­u­a­tion in a ­single ­patient can be unre­li­able. Since a ­doubtful ­response for HCV-RNA is in ­some ­cases ­obtained, fur­ther improve­ments in the diag­nosis of ­chronic HCV infec­tion are ­needed.

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