Seroprevalence of Hepatitis C virus (HCV) infection and role of serological and molecular assay in HCV detection and management: A step towards achieving the aim of National Viral Hepatitis Control Program (NVHCP)

Purpose: Hepatitis C virus (HCV) is a small, enveloped, single stranded RNA virus of Flaviviridae family. HCV causes both acute and chronic infection. Diagnosis of HCV can be done by indirect serological tests that detect antibodies against HCV (anti-HCV) and direct test that detects and quantifies components of viral RNA particles. As per CDC recommendation; HCV testing should be initiated with anti-HCV test, those anti-HCV positive/reactive should have follow-up testing with Nucleic Acid Test. If the HCV RNA is detected, patient should be directed for the treatment with highly effective direct acting antiviral (DAA). This study aims to determine the seroprevalence of HCV infection, to estimate presumptive HCV infection by using serological assay by anti-HCV ELISA, to estimate the current HCV infection by detecting HCV-RNA using RT-PCR molecular assay and, to highlight the role of HCV RNA for initiation of treatment. Methods: This study is retrospective observational analysis of 36500 samples obtained for anti-HCV ELISA test from Jan to Dec 2022. The ELISA kit used was a 3rd generation sandwich assay. All ELISA positive samples were tested for HCV RNA, by automated qRT-PCR method. Results: Out of 36500 samples, 361 tested positive by anti-HCV ELISA with 0.9% seroprevalence. Out of 361, only 336 were tested for HCV RNA. Of 336, 240 samples were negative as target not detected, and 96 samples showed values as viral copies in IU/mL. Most common age group affected was 18-40 years, for both serology and molecular test. Conclusion: In current study, only 96 samples showed viral copies indicating current HCV infection and need to start treatment. Hepatitis C is curable; with the availability of highly effective DAA both in a brand and generic form can cure > 95% of infected people, so the possibility of achieving the target of elimination HCV by 2030 can be predicted.