Diagnostic tests for hepatitis C.

Diagnostic tests for hepatitis C can be divided into the following two general categories: 1) serological assays that detect antibody to hepatitis C virus (anti-HCV); and 2) molecular assays that detect, quantify, and/or characterize HCV RNA genomes within an infected patient. Serological assays have been subdivided into screening tests for anti-HCV, such as the enzyme immunoassay (EIA), and supplemental tests such as the recombinant immunoblot assay (RIBA). Three generations of anti-HCV tests have been developed, and each generation has resulted in an improvement in the sensitivity of detecting anti-HCV. Supplemental anti-HCV tests are designed to resolve false-positive testing by EIA, and are appropriately used in low-prevalence settings in which false-positive anti-HCV tests remain a problem. Third-generation anti-HCV tests (EIA-3 and RIBA-3, respectively) contain antigens from the HCV core, nonstructural 3, nonstructural 4, and nonstructural 5 genes. Detection of HCV RNA in patient specimens by polymerase chain reaction (PCR) provides evidence of active HCV infection and is potentially useful for confirming the diagnosis and monitoring the antiviral response to therapy. Optimal HCV PCR assays at present have a sensitivity of less than 100 copies of HCV RNA per milliliter of plasma or serum. Standardization and proficiency testing of diagnostic laboratories performing HCV PCR remains an important problem for future study. Two main technologies exist for assessing HCV RNA levels or viral load. Quantitative PCR is the most sensitive test for determining hepatitis C viral load, whereas the branched-chain DNA test appears to be the most precise method. Major limitations of the current tests are inadequate dynamic range and high variability of PCR-based assays, and poor sensitivity of the branched-chain DNA test. Molecular tests have also been developed to classify HCV into distinct genotypes; the clinical importance of HCV genotype determination remains a subject for future investigation.