Challenges in Anti-HCV Screening: A Retrospective Analysis and Pooled Data Review from Türkiye

INTRODUCTION: The availability of appropriate screening and diagnostic procedures for hepatitis C virus (HCV) is critical for early diagnosis, reduction in mortality and morbidity, and HCV elimination. In our study, we aimed to evaluate the appropriateness of HCV testing procedures and HCV prevalence both in our hospital and across Türkiye.
METHODS: HCV screening and confirmation procedures performed in our hospital between 01.01.2021 and 01.12.2022 were retrospectively evaluated. In the literature review phase, a pooled analysis was conducted using data from studies performed in Türkiye between 01.01.2019 and 21.12.2024 with a methodology parallel to ours.
RESULTS: A total of 25,137 patients underwent anti-HCV testing, with 181 positive cases (0.72%). After the exclusion process, 151 anti-HCV positive patients remained. Among them, one patient (0.6%) was HCV RNA positive, 76 patients (50.3%) were HCV RNA negative after a history of HCV treatment, and 74 patients (49%) were HCV RNA negative without any treatment history (false anti-HCV positive or HCV spontaneous clearance). The mean and median S/CO ratio in false-positive patients were 11.6±19.21 and 2.5 (IQR: 6.89), respectively. Additionally, the mean and median S/CO ratio in true-positive patients were 74.8±36.43 and 69.45 (IQR: 47.15), respectively. According to the pooled data analysis, the seropositivity rate was 1.3% (range: 0.21%-2.46%), with 13,992 of 1,079,492 anti-HCV tests testing positive. A reflex HCV RNA confirmation test was performed in 77.44% of anti-HCV positive patients, and the confirmed disease rate was 42.5%. In these patients, the minimum anti-HCV S/CO ratio ranged from 1.81 to 12.3, while the optimal S/CO threshold was between 5 and 15.85.
DISCUSSION AND CONCLUSION: Our results indicate that the probability of false anti-HCV positive results is very high, especially when the anti-HCV S/CO ratio is low. Although HCV endemicity remains low in our region, anti-HCV screening is inadequate, and clinicians should be more aware of this issue.