Rice, P.S.; Ang, L.; Shin, G.-Y.; Maxwell, D.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA107
Academic Journal
One of the key aims of the Department of Health's strategy on reducing the burden of infectious diseases is to prevent the wider spread of hepatitis C infection. This can be achieved, however, only if there is an improved understanding of the current extent of the spread of infection in intravenous drug users. Every opportunity should therefore be made to improve the uptake of testing as this is a notoriously difficult group to persuade to accept testing. The reasons for this are many but include poor venous access, testing available only off-site due to lack of suitably trained staff, and fear of needles. There are two alternatives to venous samples, however, namely a capillary blood sample in the form of a dried blood spot (DBS) or saliva. These can be administered on-site immediately after patient consent has been obtained and have none of the disadvantages associated with standard venepuncture. We have assessed the diagnostic utility of such samples among patients of known HCV status attending hepatology clinics at St George's. To perform testing we modified the standard protocol of the Ortho third generation EIA and employed an in-house nested HCV RT-PCR on DBS samples. A total of 65 patients provided both DBS and saliva samples. Ali of the 24 HCV antibody negative patients by conventional venous blood testing were antibody negative in DBS and saliva. Of the 41 HCV antibody positive patients, 39/41 (95%) and 25/41 (61%) were antibody positive by dried blood spot and saliva, respectively. Of the two false negative patients on DBS one was only weakly antibody positive with standard methodology, the other had recovered infection. Additionally we tested DBS samples from 24 HCV antibody positive patients by RT-PCR; 20/24 (83%) were viraemic, thus establishing chronic infection. This pilot study has shown that dried blood spot samples are easy to administer, have high sensitivity, and specificity and should be offered where venous testing has previously had a...


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