Hepatitis C Core-Antigen Testing from Dried Blood Spots

In order to expand hepatitis C virus (HCV) screening, a change in the diagnostic paradigm is warranted to improve accessibility and decrease costs, such as utilizing dried blood spot (DBS) collection. In our study, blood from 68 patients with chronic HCV infection was spotted onto DBS cards and stored at the following temperatures for one week: -80 degrees C, 4 degrees C, 21 degrees C, 37 degrees C, and alternating 37 degrees C and 4 degrees C; to assess whether temperature change during transportation would affect sensitivity. Sample was eluted from the DBS cards and tested for HCV antibodies (HCV-Ab) and HCV core antigen (core-Ag). HCV-Abs were detected from 68/68 DBS samples at -80 degrees C, 4 degrees C, 21 degrees C, and 67/68 at 37 degrees C and alternating 37 degrees C and 4 degrees C. Sensitivity of core-Ag was as follows: 94% (-80 degrees C), 94% (4 degrees C), 91% (21 degrees C), 93% (37 degrees C), and 93% (37 degrees C/4 degrees C). Not only did temperature not greatly affect sensitivity, but sensitivities are higher than previously reported, and support the use of this assay as an alternative to HCV RNA. We then completed a head-to-head comparison (n = 49) of venous versus capillary samples, and one versus two DBS. No difference in core-Ag sensitivity was observed by sample type, but there was an improvement when using two spots. We conclude that HCV-Abs and core-Ag testing from DBS cards has high diagnostic accuracy and could be considered as an alternative to HCV RNA in certain settings.