Evolving strategy for HCV testing in an Italian tertiary care hospital

Background: Diagnostic tests for hepatitis C virus (HCV) infection should be adapted according to theclinical status of the patient.Objectives: We exploited the application of different HCV diagnostic algorithms in a tertiary care hospital practice. Study design: The laboratory clinical reports to the medical orders for HCV testing during three yearswere clustered by different combinations of assays for anti-HCV antibodies (HCV Ab) (screening andconfirmatory), HCV nucleic acid (HCV-RNA), HCV core antigen (HCV Ag). The latter was the first-lineassay in acute HCV infections requiring a rapid assessment of the infectious state. Results: The majority (91.9%) of the 2726 subjects whose samples were analyzed were inpatients. Most ofthe patients/subjects were tested for clinical suspicion of viral hepatitis (49.2%), or occupational accidentto health care professionals (20.0%). On 66% of samples HCV Ag test alone was performed and resultedpositive in 116 cases (6%), while it was detected in 50.3% of anti-HCV positive samples. The agreementbetween HCV Ag and HCV-RNA was very high (k = 0.97); HCV Ag positivity rates increased according tothe signal of the HCV Ab screening test. Conclusions: The use of different testing strategies according to the patients’ history and clinical statusallowed a significant reduction of the number of tests performed and the time needed to provide a diag-nostic response useful for patients’ management without compromising the overall diagnostic accuracyfor HCV infection.