Diagnostic Accuracy of HCV Core Antigen for Acute HCV in HIV-1 Patients
Overview
This systematic review and meta-analysis evaluated the diagnostic performance of hepatitis C virus core antigen (HCVcAg) for detecting acute or recent HCV infection in people with HIV-1 (PWH). The pooled sensitivity and specificity of HCVcAg were 92% and 99%, respectively, supporting its use as a reliable diagnostic tool in this population.
Background
Hepatitis C virus (HCV) infection causes chronic liver disease and remains a significant global health challenge, especially among high-risk groups such as people with HIV-1 (PWH). Early diagnosis of acute HCV infection in PWH is critical due to accelerated disease progression and ongoing transmission risk. Traditional anti-HCV antibody testing has limitations in acute infection detection due to delayed seroconversion, while nucleic acid amplification tests (NAATs), though the gold standard, are costly and less accessible in resource-limited settings. HCV core antigen (HCVcAg) testing offers a potentially cost-effective and rapid alternative for early diagnosis.
Data Highlights
Parameter
Range
Pooled Estimate (95% CI)
Sensitivity
87.1% - 100%
92% (78%–98%)
Specificity
95.0% - 100%
99% (97%–100%)
Positive Predictive Value (PPV)
Based on incidence 8.46/1000 person-years
44% (18%–100%)
Negative Predictive Value (NPV)
Based on incidence 8.46/1000 person-years
100% (99%–100%)
Key Findings
HCVcAg demonstrated high sensitivity (87.1% to 100%) and specificity (95.0% to 100%) for diagnosing acute or recent HCV infection in PWH.
The meta-analysis pooled sensitivity was 92% and specificity was 99%, indicating excellent diagnostic accuracy.
Positive predictive value was moderate (44%) due to low incidence rates, but negative predictive value was very high (100%), supporting its use to rule out infection.
HCVcAg testing offers a shorter assay time and reduced cost compared to NAATs, making it suitable for resource-limited settings.
Early detection of acute HCV infection in PWH is essential to initiate timely direct-acting antiviral treatment and reduce onward transmission.
Integration of HCVcAg into screening protocols for PWH could improve identification of acute infections and support hepatitis C elimination goals.
Clinical Implications
HCV core antigen testing provides a reliable, rapid, and cost-effective alternative to NAATs for diagnosing acute HCV infection in people with HIV-1. Its high negative predictive value makes it particularly useful for ruling out infection in high-risk populations. Incorporating HCVcAg into routine screening protocols can facilitate earlier diagnosis and treatment initiation, ultimately aiding in hepatitis C control and elimination efforts among PWH.
Conclusion
HCV core antigen testing exhibits excellent diagnostic performance for acute HCV infection in people with HIV-1, supporting its clinical utility as a practical alternative to nucleic acid testing. Its adoption in screening strategies can enhance early detection and treatment, contributing to improved patient outcomes and public health goals.
References
Systematic Review and Meta-Analysis 2024 -- Evaluating the Diagnostic Accuracy of HCV Core Antigen for Acute HCV Infection in Individuals with HIV-1
