DIAGNOSIS OF HEPATITIS-C

Currently, the second-and third-generation enzyme immunoassays (EIA-2 and EIA-3) for hepatitis C virus antibody (anti-HCV) are the most prac tical screening tests for the diagnosis of HCV infection. The need for and the choice of supplementary or confirmatory tests depend on the c linical setting and the likelihood of a true-positive EIA result. Dete ction of HCV RNA in serum by polymerase chain reaction (PCR) assay is the gold standard for the diagnosis of HCV infection. However, the lac k of uniformity in current FCR assays has tarnished this standard. Con firmatory tests for the diagnosis of HCV infection are in general unne cessary in anti-HCV-positive patients who present with chronic liver d isease. When indicated, the most appropriate test in this setting is a qualitative PCR assay for HCV RNA. Confirmatory tests should always b e performed in anti-HCV-positive blood donors and individuals with nor mal aminotransferase levels. The most appropriate approach is to retes t for anti-HCV using recombinant immunoblot assay (RIBA) and then test for HCV RNA using PCR assay in those who are RIBA positive or indeter minate. fiver histology is the gold standard in assessing severity of liver disease. Quantitative tests for serum HCV RNA levels do not help to determine the severity of liver disease. At the moment, HCV genoty ping should be considered a research tool and not a part of the diagno stic work-up in clinical practice. The goals of treatment for chronic hepatitis C are sustained biochemical and virological response. Viral clearance should be determined by qualitative PCR assay. Quantifying s erum HCV RNA level can help in predicting response to interferon treat ment, but further studies using more standardized assays are needed to determine if these values can be used to select patients for treatmen t.