Diagnosis of acute hepatitis C virus infection and estimated incidence in low- and high-risk English populations
Diagnosis of acute hepatitis C virus infection and estimated incidence in low- and high-risk English populations
复制标题
DOI：
10.1111/j.1365-2893.2008.01009.x
复制
发表时间：
2008-12-01
影响因子：
2.5
通讯作者：
Irving, W. L.
中科院分区：
文献类型：
--
作者：
Brant, L. J.;Ramsay, M. E.;Irving, W. L.
急性丙型肝炎病毒（HCV）感染的诊断并不简单;很少有人表现出临床症状，基因组/抗原检测技术不能表明感染发生的时间。在这里，一个战略，以检测HCV RNA的抗体（“窗口期”）的情况下，诊断急性感染进行评估。肝炎检测研究的哨点监测用于回顾性识别来自高危个体的抗-HCV阴性样本（2002-2003年），用于单独检测HCV RNA。前瞻性（2005年）确定了其他样本，并在合并液中检测了HCV RNA。对阳性样本进行基因分型。采用合并策略的发生率和成本进行了估计。在回顾性研究中，8/390例（2.1%）样本证实HCVRNA阳性，抗-HCV阴性。因此，在325个样本池中检测了3237份样本。5个阳性样本池确定了4名确认的HCV RNA阳性患者（1名假阳性）。注射吸毒者（IDUs）的估计发病率为12.9/100人年（回顾性研究），吸毒/酗酒服务和监狱参与者的估计发病率为3.7/100人年（前瞻性研究）。在风险较高的地区，每个阳性样本的估计成本为850磅。窗口期策略的收益率取决于测试的人口。对当前注射吸毒者的抗-HCV阴性样本进行合并HCV RNA检测是现实的，并且相对便宜，可用于识别最近感染的个体。
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 pound 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.