Abstract:
Many developing countries are reluctant to intensively screen blood bank samples
and employ genotype specific treatment strategy for Hepatitis C virus (HCV). This
is mainly due to high costs, time and high technical skill requirements associated
with Nucleic Acid Amplification Technology (NAT)-based tests. The study aimed
to evaluate Monolisa® HCV Antigen-Antibody Ultra (Bio-Rad Laboratories
Limited, Marnes La Coquette, France), a new combination ELISA assay designed to
detect in parallel antigens for and antibodies to HCV, and further determine the
genotyping performance of Restriction Fragment Length Polymorphism (RFLP)
assay on HCV genotypes 1 to 4 samples. The study involved retrospective and
prospective analysis of samples stored at the Max von Pettenkofer Institute (MvPI)
and samples obtained from patients attending HCV treatment at the two main
Ludwig Maximillian University hospitals in Germany. Sensitivity, Specificity and
Predictive values of the new ELISA kit was evaluated and compared with the
AXSYM HCV version 3.0 (Abbot Diagnostics, Germany), an antibody based
ELISA kit. Seventy four samples were tested on the two ELISA assays while fifty
PCR positive samples were genotyped by Restriction Fragment Length
Polymorphism assay. The study further measured the viral loads of twelve samples
using random primers and compared the results with the measurements obtained by
5’UTR specific primers. The two ELISA assays realized comparable results both
recorded a similar sensitivity of 91% with positive predictive values of 100% and
98% for the two assays respectively. Specificity of Monolisa® HCV Ag-Ab Ultra was recorded as 100% with a negative predictive value of 87% against a specificity
of 93% with a negative predictive value of 86% recorded for AxSYM. Two samples
with high viral loads of 780.000 and 8.900.000 IU/mL were not detected by the
Monolisa® HCV Ag-Ab Ultra assay. Genotyping of these two samples revealed
genotype 1b, a HCV-subtype. Restriction Fragment Length Polymorphism assay
genotyped and showed clear results on forty two (84%) samples, unclear results on
six (12%) samples and conflicting results on two (4%) of the fifty samples
genotyped. Although RFLP realized difficulty with genotype 2 samples, all other
genotypes were easily genotyped. Finally the study showed similarity in the viral
load measurements between random and specific primers. The study concludes that
although Monolisa® HCV Antigen-Antibody Ultra assay depicts high sensitivity and
specificity in detecting antibodies to HCV, it does not add further benefit to detect
HCV infections by enhanced sensitivity due to the potential contingency to trace
viral capsid antigens, a fact that needs further evaluation. On the other hand, RFLP
is an effective genotyping tool among HCV genotypes 1 to 4. The study also reveals
the importance of random primers and asserts the primers as a point of focus in the
future projection in Hepatitis C genotyping. It recommends further evaluations of
these assay platforms using Kenyan samples, as their introduction would be
instrumental in HCV diagnosis and management in Kenya. This work provides a
baseline for further studies on evaluation of antigen sensitivity of Monolisa® HCV
Antigen-Antibody Ultra, restriction performance of various enzymes used in RFLP
genotyping and performance of random primers in HCV diagnosis.