Background
- Hepatitis C virus (HCV) becomes chronic in up to 80% of infected individuals
- Chronic infection increases the risk of:
- Decompensated cirrhosis
- Hepatocellular carcinoma
Good News: Treatment Works
- New direct-acting antivirals (DAAs) are highly effective
- Up to 99% cure rate with a 12-week course
- Pan-genotypic DAAs eliminate the need for genotype testing before starting treatment
Why Change the Diagnostic Approach?
- Only 20% of infected individuals are aware of their status
- Just 15% have received treatment
- WHO targets by 2030:
- Treat 80% of eligible HCV cases
- Reduce HCV incidence by 90%
- Reduce HCV-related deaths by 65%
High-Risk Groups to Screen
- People who inject drugs (PWID)
- Men who have sex with men (MSM)
- Individuals who received blood products before 1992
- Patients exposed to unsafe injections or poor infection control
Lab Tests for HCV Diagnosis
1. HCV Antibody Test
- Mnemonic: HEPC
- Detects exposure to HCV
- A negative result excludes HCV (unless very recent exposure)
- A positive result requires confirmation with a viral detection test
- Not suitable for detecting reinfection after treatment
2. HCV Immunoblot (Western Blot)
- Mnemonic: HEPCWB
- Used in low prevalence settings where false positives are more likely
- Helps confirm or exclude low-level positive antibody results
3. HCV PCR / Viral Load
- Mnemonic: HEPCPCR or HCVVL
- Gold standard for confirming active infection
Also used to confirm sustained virological response (SVR) after treatment- Performed in centralised molecular labs
4. HCV Core Antigen Test (New!)
- Mnemonic: HEPCAG
- Surrogate marker for active HCV infection
- Detects viral replication at >3000 IU/mL
- More cost-effective and accessible than PCR
- Uses same specimen as the antibody test
- Suitable for high-throughput, decentralised testing
5. HCV Genotyping
- Mnemonic: HCVGEN
- No longer routinely required before treatment, thanks to pan-genotypic DAA therapy
- May still be helpful in select cases
New Ampath Diagnostic Algorithm for HCV
Ampath has introduced a simplified, one-step algorithm to confirm HCV infection and guide treatment:
Diagnostic Workflow:
HCV Antibody EIA Positive?
Proceed with HCV Core Antigen Test
Positive→ HCV infection confirmed → Assess for DAA treatment
Negative→ Likely past/resolved infection or false positive→ Consider HCV PCR if clinical suspicion remains
HCV Antibody EIA Low Positive?
Perform HCV Immunoblot-->If confirmed positive → Add HCV Core Antigen or PCR to check viraemia
Note: Supplemental tests are not automatically performed for cash-paying patients.