IN THE general ranking of the most effective actions to win the difficult battle against hepatitis C, early diagnosis is positioned directly in the top list as an indispensable tool to block the progression and transmission of the disease. This explains why in the last period – especially after the arrival of highly effective antivirals – increasingly sophisticated screening tests have been studied and carried out, with the aim of bringing out the submerged cases and leading to the global elimination of HCV, the virus responsible for hepatitis C, by 2030, as established by the World Health Organization (WHO).
Among these, there is a new immunoassay, the Elecsys HCV Duo, capable of identifying from a plasma or serum sample not only antibodies but simultaneously also the antigen of the virus, detecting the infection from the early stages.
Less withdrawals and more timely interventions
To diagnose hepatitis C, a serological test is now performed to look for anti-HCV antibodies produced in response to the infection. This is a useful test to determine if you have come into contact with the virus, but not to ascertain whether it is a past or ongoing infection. To verify this it is necessary to perform another blood test (HCV-RNA) and measure the viral load, that is the quantity of viral particles present in the blood through the quantification of RNA.
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The new Elecsys HCV Duo test, on the other hand, is able to provide both information with a single sample, detecting the core antigen and the virus antibodies simultaneously and independently. The core antigen is in fact present from the beginning of the infection and is therefore a marker that signals whether viral replication is in progress. Because it allows for early disease detection, the test can also be used as a screening to prevent hepatitis transmission in blood transfusions and organ and tissue transplantation. And, consequently, to promptly intervene on patients with the most appropriate therapies, reducing the number of additional withdrawals and tests, and the costs for the health system. The test, in Italy since September, can be used with other laboratory tests and clinical data for the diagnosis of the infection.
How the virus spreads
Hepatitis C is transmitted through contact with infected blood, which can occur with the exchange of needles and syringes (a widespread practice among drug addicts), the use of improperly sterilized medical equipment, needle wounds in the health sector, tattoos or piercings done in places or with instruments that are not adequately sanitized, transfusions of infected blood, transplants and grafts of organs and tissues, and in a few cases sexually or parental from an infected mother to the fetus. Today, however, the risk of contagion is much lower than in the past, thanks to the implementation of protocols for donor screening and best hygiene practices. The liver is primarily affected: an immune reaction is triggered which, in the long term, irreversibly damages the organ, leading to cirrhosis and cancer. But over time, diabetes, kidney failure and cardiovascular disease can also occur.
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Why it is important to eliminate the virus
According to the WHO, in 2019 there were 1.5 million new hepatitis C infections and 290,000 deaths, more than those due to HIV or malaria. The biggest problem for the health authorities is what concerns the undeclared, because those affected by the virus often have no symptoms for a long time. Out of 58 million chronic HCV carriers, most of them are unaware that they have contracted the virus. In Italy it is estimated that almost 300,000 are unaware of the infection. Early diagnosis is therefore all the more important. Today, with the available therapies, it is possible to eliminate the virus from the body in over 90% of cases and thus neutralize the possibility of transmitting it to other people.