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2020, Cilt 50, Sayı 2, Sayfa(lar) 078-085
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Do Clinicians Adequately Interpret HCV-RNA Results in Anti-HCV-Positive Samples? An Analysis of 10-Year Data
Reyhan Yiş1, Selma Tosun2, Hilal Küpeli2, Fulya Demircan2
1Sağlık Bilimleri Üniversitesi İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Tıbbi Mikrobiyoloji, İzmir, Türkiye
2Sağlık Bilimleri Üniversitesi İzmir Bozyaka Eğitim ve Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, İzmir, Türkiye
Keywords: anti-HCV, HCV-RNA, diagnostic algorithm, Rational Laboratory Use Project, reflex testing

Objective: Hepatitis C virus (HCV) is among the leading causes of liver-related morbidity and mortality and poses a global public health problem. When acute or chronic HCV infection is suspected, national and international guidelines recommend anti-HCV screening test as the first-line test. The HCV RNA test directly detects viral RNA and thus has the advantages of distinguishing between current and past HCV infection, and confirming anti-HCV positivity. The aim of our study was to determine the frequency of HCV RNA positivity in anti-HCV-positive serum samples and to evaluate the rate at which HCV RNA testing was ordered and also departments that did and did not request this test.

Method: We retrospectively analyzed the test results of patients whose serum samples were sent to microbiology laboratory between January 1, 2008 and January 1, 2018 for anti-HCV testing. The test results of 46.964 patients whose samples were sent from various departments to our laboratory for anti-HCV screening during the study period were included in the study. The results of the anti-HCV test were evaluated based on Sample/Cut-off(S/ COratio) (index value). HCV RNA test request status and admission to the department of infectious disease were evaluated.

Results: According to the test results of 46.964 patients, anti-HCV positivity was detected in 618 (1.24%) patients. HCV RNA test was ordered for 308 (49.84%) of these patients, while HCV RNA testing was not requested from 310 patients. Anti HCV RNA negativity was detected in 218 (70.78%) patients, while 90 (29.22 %) patients tested positive for viral load. Of the for whom was not ordered, anti-HCV screening was requested from surgical departments for (n=219, 70.6%), inpatient departments (n=81, 26.1%), and the infectious diseases department for 10 patients (3.3%). Seventy-two (80%) of HCV-RNA positive patients, 170 (78%) of HCV-RNA negative patients and 31 (10%) of patients not ordered HCV-RNA were admitted to the Infectious Diseases department.

Conclusion: In summary, we need practices that will not leave the process of confirming HCV diagnosis to chance for over half of the patients. The microbiology laboratory should establish diagnostic algorithms for HCV infection. In addition, the implementation of reflex testing as part of the Rational Laboratory Use Project by the Turkish Ministry of Health enables HCV RNA testing requested automatically for patients with positive anti-HCV test. Anti- HCV-positive patients should be referred to infectious diseases outpatient clinic with guidance notes added to their results from the diagnostic algorithm or reflex testing.


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