Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6701
Revised: January 16, 2014
Accepted: March 12, 2014
Published online: June 14, 2014
While hepatitis B virus (HBV) screening relies on hepatitis B surface antigen to confirm HBV infection since the early days of hepatitis B disease management, hepatitis C virus (HCV) infection screening is based on anti-HCV testing which does not discriminate active from past infection. Thus to confirm infection HCV RNA testing has been required; recently a HCV core antigen assay became widely commercially available which could serve to confirm infection. That assay is less sensitive than current HCV RNA assays, but as more than 50% of anti-HCV positive persons will be HCV core antigen positive, HCV core antigen testing can be a cost effective and reflex test to confirm HCV infection in anti-HCV positive individuals and will be easier as it can be applied on the same platform. For treatment monitoring, more data need to be generated, but the early data available at present suggest that HCV core antigen may be an alternative to HCV RNA monitoring. With direct antivirals, HCV core antigen could even be superior to HCV RNA testing, as direct antivirals might already prevent virus formation when HCV core antigen is still produced and thereby correlates better with eventual viral clearance.
Core tip: Hepatitis C virus (HCV) core antigen can be a cost effective alternative to confirm HCV infection, though patients with low HCV RNA (< 1000 IU/mL) have a chance of being false negative. It could have a role in therapy monitoring, but that is currently not well enough studied.