Dried Blood Spots: A Tool to Ensure Broad Access to Hepatitis C Screening, Diagnosis, and Treatment Monitoring.
BACKGROUND
With the advent of highly efficient antiviral therapies for hepatitis C virus (HCV) infection, providing broad access to diagnosis and care is needed. The dried blood spot (DBS) technique can be used to collect, store, and ship whole-blood specimens. Our goal was to assess the performance of standardized HCV diagnostic and monitoring tools in the analysis of DBS.


METHODS
Serum specimens and whole-blood specimens collected using the DBS technique from >500 patients were tested for virological markers used to diagnose and monitor HCV infection.


RESULTS
Enzyme immunoassay detection of anti-HCV antibodies in specimens from DBS was reliable after establishment of a new signal-to-cutoff ratio. HCV RNA was detected DBS from the vast majority of patients with active replication, but HCV RNA levels were substantially lower than in serum specimens, implying that only the presence or absence of HCV RNA or changes in the HCV RNA level should be taken into consideration for therapy. Detection of HCV core antigen in specimens from DBS was not a sensitive marker of chronic HCV infection. HCV genotype determination was possible in the vast majority of DBS.


CONCLUSIONS
This study shows that whole-blood specimens collected using the DBS technique can be confidently used to diagnose and monitor HCV infection. DBS could help improve access to care for HCV infection because they are suitable for use in large-scale screening programs, diagnosis, and therapeutic monitoring.
National Reference Center for Viral Hepatitis B, C, and Delta, Department of Virology INSERM U955, Centre Hospitalier Intercommunal de Créteil, France.
Alexandre
A
Soulier
National Reference Center for Viral Hepatitis B, C, and Delta, Department of Virology INSERM U955, Centre Hospitalier Intercommunal de Créteil, France.
Lila
L
Poiteau
Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal de Créteil, France.
Isabelle
I
Rosa
Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, Université Paris-Est INSERM U955, Centre Hospitalier Intercommunal de Créteil, France.
Christophe
C
Hézode
Department of Public Health, Hôpital Henri Mondor, Université Paris-Est INSERM U955, Centre Hospitalier Intercommunal de Créteil, France.
Françoise
F
Roudot-Thoraval
National Reference Center for Viral Hepatitis B, C, and Delta, Department of Virology INSERM U955, Centre Hospitalier Intercommunal de Créteil, France.
Jean-Michel
JM
Pawlotsky
National Reference Center for Viral Hepatitis B, C, and Delta, Department of Virology INSERM U955, Centre Hospitalier Intercommunal de Créteil, France.
Stéphane
S
Chevaliez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003890:Desiccation; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D012367:RNA, Viral / Q000097:blood*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D055815:Young Adult
D018937:Hepatitis C Antibodies; D012367:RNA, Viral
diagnosis; dried blood spot; hepatitis C virus; monitoring of HCV infection; screening