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Canadian Journal of Public Health

, Volume 91, Supplement 1, pp S36–S42 | Cite as

Diagnostic et test du virus de l’hépatite C

  • Mel KrajdenEmail author
Article

Résumé

La mise au point de tests sérologiques et de tests d’acide nucléique (TAN) a révolutionné le diagnostic du virus de l’hépatite C (VHC). Même si les dosages immuno-enzymatiques (EIA) de troisième génération sont très efficaces comme tests dans des populations où la prévalence de la maladie est élevée, des tests de confirmation sont toujours nécessaires lorsque la prévalence du VHC est faible, pour exclure les faux résultats positifs. Les limites des EIA de troisième génération comprennent le délai relativement long entre le moment d’une infection aiguë et la détection de la séroconversion (en général au moins 5 à 6 semaines), le retard de la séroconversion (plusieurs mois ou des années) chez les sujets immunodéprimés et l’incapacité pour les tests sérologiques de confirmer le caractère actif d’une infection par le VHC. Par contre, les TAN permettent de détecter directement la présence d’ARN du VHC dans le sérum, le plasma ou des tissus, et donc de confirmer une infection active et de ramener à 1 ou 2 semaines le délai entre une infection et la détection du VHC. Les TAN disponibles sur le marché sont maintenant très sensibles, spécifiques et reproductibles et ont largement remplacé les tests par amplification d’acide nucléique, artisanaux et peu fiables. Parmi les TAN commerciaux, les tests qualitatifs sont généralement plus sensibles que les tests quantitatifs et constituent donc la méthode de choix pour confirmer une infection active. Étant donné l’efficacité de la bithérapie interféron–ribavirine et des nouveaux agents antivirus en cours de mise au point, l’hépatite C pourrait devenir curable, ce qui aura probablement des effets dans l’avenir sur la transmission de la maladie. Comme les coûts du traitement sont actuellement très élevés, il y a un besoin manifeste d’évaluer l’utilité de TAN quantitatifs et d’étudier plus à fond le rôle de la détermination du génotype du VHC afin d’optimiser le traitement. Par conséquent, dans un avenir prévisible, une combinaison de tests sérologiques et de TAN demeurera nécessaire pour un diagnostic et un suivi du VHC à un coût raisonnable.

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Copyright information

© The Canadian Public Health Association 2000

Authors and Affiliations

  1. 1.BC Centre for Disease ControlLaboratory ServicesVancouverCanada

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