title: Evolving strategy for HCV testing in an Italian tertiary care hospital.
abstract: BACKGROUND
  Diagnostic tests for hepatitis C virus (HCV) infection should be adapted according to the clinical status of the patient.
  
  
  OBJECTIVE
  We exploited the application of different HCV diagnostic algorithms in a tertiary care hospital practice.
  
  
  METHODS
  The laboratory clinical reports to the medical orders for HCV testing during three years were clustered by different combinations of assays for anti-HCV antibodies (HCV Ab) (screening and confirmatory), HCV nucleic acid (HCV-RNA), HCV core antigen (HCV Ag). The latter was the first-line assay in acute HCV infections requiring a rapid assessment of the infectious state.
  
  
  RESULTS
  The majority (91.9%) of the 2726 subjects whose samples were analyzed were inpatients. Most of the patients/subjects were tested for clinical suspicion of viral hepatitis (49.2%), or occupational accident to health care professionals (20.0%). On 66% of samples HCV Ag test alone was performed and resulted positive in 116 cases (6%), while it was detected in 50.3% of anti-HCV positive samples. The agreement between HCV Ag and HCV-RNA was very high (k=0.97); HCV Ag positivity rates increased according to the signal of the HCV Ab screening test.
  
  
  CONCLUSIONS
  The use of different testing strategies according to the patients' history and clinical status allowed a significant reduction of the number of tests performed and the time needed to provide a diagnostic response useful for patients' management without compromising the overall diagnostic accuracy for HCV infection.
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy. Electronic address: mariacristina.medici@unipr.it.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Medici
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Chezzi
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy.
authors.forename: Flora
authors.initials: F
authors.lastname: De Conto
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ferraglia
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Pinardi
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Arcangeletti
authors.affiliation: Abbott Diagnostics Division, 00144 Roma, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bernasconi
authors.affiliation: Abbott Diagnostics Division, 00144 Roma, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Galli
authors.affiliation: Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, 43126 Parma, Italy. Electronic address: adriana.calderaro@unipr.it.
authors.forename: Adriana
authors.initials: A
authors.lastname: Calderaro
mesh_terms: D000465:Algorithms; D000956:Antigens, Viral; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology*; D006526:Hepatitis C / Q000175:diagnosis* / Q000276:immunology* / Q000821:virology; D018937:Hepatitis C Antibodies; D006801:Humans; D007118:Immunoassay; D007558:Italy; D058889:Molecular Typing; D012367:RNA, Viral; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers
chemical_list: D000956:Antigens, Viral; D018937:Hepatitis C Antibodies; D012367:RNA, Viral
keywords: Diagnostic algorithms; HCV antigen; HCV infection diagnosis; HCV-RNA; Hepatitis C