title: Is it possible to diagnose acute hepatitis C virus (HCV) infection by a rising anti-HCV titre rather than by seroconversion?
abstract: The diagnosis of acute hepatitis C virus (HCV) infection relies on documented positive-seroconversion of HCV antibody (anti-HCV). Because of the detection of seroconversion at an earlier stage by second or third generation anti-HCV enzyme immunoassays (EIA), the diagnosis of acute hepatitis C (AHC) may be underestimated. The aim of this study was to evaluate whether rising anti-HCV titre could be used to diagnose AHC or not. Eighteen patients with a clinical diagnosis of acute hepatitis C were enrolled, including eight cases with documented seroconversion to anti-HCV and 10 cases with clinically suspected acute hepatitis C. Four chronic hepatitis C patients with acute exacerbation were selected as a control group. Serial sera were assayed with a third generation anti-HCV (AxSYM, version 3.0; Abbott, Chicago, IL, USA) and recombinant immunoblot assays (RIBA; Chiron HCV 3.0 Strip; Immunoblot, Emeryville, CA, USA) and the titre of anti-HCV expressed as signal/cutoff (S/CO) ratio and the RIBA patterns were correlated. Seven of eight documented AHC (one lacking the initial serum) and five of 10 clinically suspected AHC showed a rising pattern of S/CO values. The initial S/CO values on the first visit were less than 40 in 14 of 18 cases. The RIBA pattern shifted from negative/indeterminate to positive in five of seven documented AHC and 4 of 10 clinically suspected AHC cases. Fifteen of 18 cases had seroconversions of at least one antibody, whilst 85.7% showed a rising S/CO ratio. On the contrary, the S/CO ratio and RIBA pattern remained unaltered in chronic hepatitis C with acute exacerbation. The rise in S/CO was usually accompanied with an increase in the number of RIBA reactive bands and their intensity in acute hepatitis C patients. The rise in S/CO ratios using a third generation anti-HCV assay and the RIBA pattern might be used as a supplemental diagnostic criterion for acute HCV infection.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Niaosung, Kaohsiung, Taiwan. juten@ms17.hinet.net
authors.forename: S-N
authors.initials: SN
authors.lastname: Lu
authors.forename: H-D
authors.initials: HD
authors.lastname: Tung
authors.forename: T-M
authors.initials: TM
authors.lastname: Chen
authors.forename: C-M
authors.initials: CM
authors.lastname: Lee
authors.forename: J-H
authors.initials: JH
authors.lastname: Wang
authors.forename: C-H
authors.initials: CH
authors.lastname: Hung
authors.forename: C-H
authors.initials: CH
authors.lastname: Chen
authors.forename: C-S
authors.initials: CS
authors.lastname: Changchien
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000175:diagnosis* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D015151:Immunoblotting; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins / Q000276:immunology; D017361:Viral Nonstructural Proteins / Q000235:genetics / Q000276:immunology; D012324:RNA-Dependent RNA Polymerase
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D011994:Recombinant Proteins; D017361:Viral Nonstructural Proteins; C087036:NS-5 protein, hepatitis C virus; D012324:RNA-Dependent RNA Polymerase