# Real-Time Polymerase Chain Reaction in Detecting Active Hepatitis C Virus Infection: A Retrospective Analysis

## TL;DR

This study shows that real-time PCR testing is more reliable than antibody tests for detecting active hepatitis C virus infections, especially in older adults.

## Contribution

The study provides new insights into the proportion of active HCV infections and the association between viral load and liver enzyme levels in a tertiary care setting.

## Key findings

- 25.6% of 383 HCV-screened patients tested positive for active HCV RNA.
- Older adults (≥60 years) had a significantly higher rate of HCV RNA positivity.
- Higher viral loads were significantly associated with elevated liver enzymes.

## Abstract

Introduction

Hepatitis C virus (HCV) infection is a major worldwide health concern. It is a major cause of cirrhosis, hepatocellular carcinoma, and chronic hepatitis. Testing for anti-HCV antibodies is common for screening purposes, but it does not distinguish between an active and a past infection. A real-time polymerase chain reaction (RT-PCR)-based detection of HCV ribonucleic acid (RNA) is used to confirm active infection following initial serological screening. The current study aimed to assess the proportion of HCV RNA positivity, the distribution of viral load, and its association with demographic, serological, and biochemical markers in patients screened for HCV infection.

Materials and methods

This study was a retrospective analysis carried out at a tertiary care hospital in Chennai, India. It involved 383 patients who were screened for hepatitis C virus infection between July 2023 and July 2024. HCV RNA detection and viral load quantification were performed using RT-PCR. Testing for anti-HCV antibodies was carried out using a chemiluminescent microparticle immunoassay (CMIA). The liver function parameters were obtained from laboratory records at the time of HCV testing. The clinical details of the study patients were assessed retrospectively from the medical records. Demographic details such as age, gender, and clinical diagnosis were collected. The results were tabulated, and statistical analysis was performed.

Results

Of the 383 individuals tested, 98 (25.6%) were positive for HCV RNA. Individuals aged ≥60 years constituted 56.6% of cases within that age group and accounted for the majority of HCV RNA-positive individuals, demonstrating a statistically significant association with HCV RNA positivity (chi-square {χ²} = 88.37; p < 0.001). Women demonstrated a higher HCV RNA positivity rate (30.0%) compared to men (23.6%), though this difference was not statistically significant (p = 0.181). Viral load analysis showed that 51.0% of individuals had low-level viremia (11-100,000 IU/mL), while 26.5% had viral loads exceeding 500,000 IU/mL. Liver enzyme elevation did not differ significantly between dialysis and non-dialysis groups (p = 0.586). However, a significant association was observed between higher viral load (>500,000 IU/mL) and liver enzyme elevation (p = 0.030). Among HCV RNA-positive individuals, 29.6% were nonreactive for anti-HCV antibodies.

Conclusion

This study focuses on the importance of molecular testing for detecting active HCV infections in tertiary care settings. Compared to conventional screening methods, HCV RNA testing provides a more reliable confirmation of active disease.