High Frequency of HCV Infection in Individuals with Isolated Antibody to Hepatitis B Core Antigen

Abstract

Although isolated antibody to hepatitis B core antigen (anti-HBc) is frequently nonspecific or may be the only serological marker of past self-limiting hepatitis B, where antibodies against the surface antigen have disappeared, isolated anti-HBc seropositivity is frequently associated with chronic hepatitis B in HIV- and HCV-infected individuals. Of 5,520 samples that tested positive for anti-HBc (IMx and AxSYM CORE, Abbott, Delkenheim, Germany) at the Institute of Virology, University Clinic Frankfurt during the time interval from January 1994 to February 1996, 643 (11.6%) were isolated anti-HBc-reactive in the IMx and AxSYM CORE assays (inhibition values >90%). There was a statistically significant association between isolated anti-HBc seropositivity and HCV and HIV/HCV coinfection (p < 0.05). A total of 190 samples were available for further testing. Six (3.2%) of 190 isolated anti-HBc-positive samples were considered false-positive since they were only positive in the AxSYM or IMx CORE assay and a linear decrease of the measured signal could not be observed in dilution series. Of 184 serum samples tested with nested PCR using primers of the S genome region, only 6 (3.3%) were HBV DNA-positive. Anti-HBc-IgM antibody could be detected in 3 (1.6 %) of the tested samples using the IMx CORE-M. With the more sensitive VIDAS HBc IgM specific IgM antibody was detected in 15 (8.5%) of 177 samples at concentrations ranging from 10 to >200 Paul Ehrlich Institute U/ml. HIV or HCV coinfection was present in 28.1% and 37.5% of isolated anti-HBc-positive individuals, respectively. We conclude from our observations that only a limited proportion of anti-HBc-isolated individuals are potentially infectious, however anti-HBc-IgM which is detectable in any form of liver disease associated with HBV infection was present in more than 8% of the individuals. Of isolated anti-HBc-positive sera 37% were positive for anti-HCV, suggesting that anti-HCV antibody testing should be performed in isolated anti-HBc-positive individuals.

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

“…Forty-four of 545 "anti-HBc alone" patients had circulating HBV-DNA with less than 1 000 copies/ml. Depending on the sensitivity of the PCR assay, the proportion of HBV-DNA carriers in this study (8.1%; detection limit 50 HBV-DNA-copies/ml) complies with other studies reporting carrier rates of 3.3% and 7.7% (detection limits of 5 000 and 100 HBV-DNA copies/mL, respectively) in unselected German individuals or blood donors [2,6] . Even more "anti-HBc alone" individuals with very low viremia would probably be found if the sensitivity of the assay were increased.…”

(152) Isolated antibody to hepatitis B core antigen in patients with chronic hepatitis C virus infection

“…The possible limitations of the present study include; First, KFSH&RC is a tertiary center, which raises a question regarding the generalizability of the findings. However, studies conducted in Europe show similar results [10,24,25] , which suggest that our conclusions are not specific to a particular geographic region. Second, we tested subjects for total anti-HBc level, rather than IgG and IgM isotypes.…”

Evaluation of Two New Automated Assays for Hepatitis B Virus Surface Antigen (HBsAg) Detection: IMMULITE HBsAg and IMMULITE 2000 HBsAg

“…Another explanation for isolated HBsAg-positive results may be the absence of anti-HBc antibody response as a consequence of iatrogenic or acquired immunodeficiency. Occasionally, anti-HBc reactivity is absent in patients with selective immunodeficiency or immunocompromised HBsAg carriers (2,10,19,20,25,(32)(33)(34).…”