Journal of the Formosan Medical Association (May 2021)

Feasibility of anti-HCV reflex HCV Ag screening strategy in an HCV endemic community

  • Wei-Ming Chen,
  • Chih-Yi Lee,
  • Nien-Tzu Hsu,
  • Wei-Cheng Huang,
  • Mei-Yen Chen,
  • Tung-Jung Huang,
  • Sheng-Nan Lu

Journal volume & issue
Vol. 120, no. 5
pp. 1237 – 1241


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Background/Purpose: The HCV core antigen (HCV Ag) assay displays high sensitivity and strong correlation with HCV RNA. However, the feasibility of anti-HCV reflex HCV Ag screening in a community-wide setting is rarely discussed. Methods: We performed a two-phase community-based hepatitis C screen in an HCV-prone area of central Taiwan. During the training phase, all participants were test for anti-HCV, HCV Ag and HCV RNA to validate sensitivity, specificity, and accuracy of HCV Ag. During the validation phase, an anti-HCV reflex HCV Ag screen was conducted based on the results of training phase. Outcomes of the study were presented as positive and negative predictive values (PPV and NPV). Results: Of 935 training phase participants, the rate of positive anti-HCV and HCV Ag were 175 (18.7%) and 78 (8.3%), respectively. Test sensitivity, specificity, and accuracy of HCV Ag were 97.1%, 98.6%, and 97.8%, respectively. During validation phase, only anti-HCV-positive serum samples were tested for HCV Ag. Of 1932 participant, 285 (14.8%) were anti-HCV-positive. 133 (46.7%) of the 285 anti-HCV-positive samples were HCV Ag-positive. PPV and NPV were 98.4% and 99.3%, respectively. Across the entire participant sample, a significant linear correlation between HCV Ag and HCV RNA concentration was noted (r2 = 0.93, p-value<0.001) following log–log transformation. Conclusion: Anti-HCV reflex HCV Ag screening is a feasible strategy for aiding HCV-prone communities.