Isolated Antibody to Hepatitis B Core Antigen in Human Immunodeficiency Virus Type-1--Infected Individuals

Abstract

We screened 651 human immunodeficiency virus (HIV)-1-infected subjects for hepatitis B surface antigen (HBsAg) and antibody to hepatitis B surface antigen (anti-HBs). Of a total of 387 subjects who tested negative for both HBsAg and anti-HBs, 142 underwent further testing for isolated presence of antibody to hepatitis B core antigen (anti-HBc). Of these 142 subjects, 60 (42%) tested positive for anti-HBc (isolated anti-HBc). Individuals coinfected with HIV-1 and hepatitis C virus (HCV) were more likely to have isolated anti-HBc than were subjects with HIV-1 alone (80% vs. 16%, respectively). Our findings suggest that individuals with HIV-1/HCV coinfection for whom there is no serological evidence for hepatitis B virus when screened with HBsAg and anti-HBs will be positive for anti-HBc in >75% of cases. A screening strategy that tests only for HBsAg and anti-HBs in HIV-1-infected patients will miss a large number of individuals with isolated anti-HBc.

Seroprevalence of Hepatitis B and C Viruses Among Children in Kilimanjaro Region, Tanzania

“…Both patients had detectable HIV-1 RNA levels, although only at 235 and 285 copies/mL; 1 had a CD4-lymphocyte percentage below threshold for age (21%); and both were receiving 3TC-containing HAART for just over 1 year. The presence of isolated HBcAb is common among HIV-infected individuals and has been associated with the presence of concurrent HCV infection [32][33][34]. Whether the results for these 2 patients reflect immunity with undetectable HBsAb, occult HBV infection, or a false-positive HBcAb result is unclear.…”

“…Standard 3-dose HBV vaccine regimens confer protection in >95% of immunocompetent children [35], but HIVinfected children have lower seroconversion rates. Even when seroconversion does occur, attrition of antibody with time, even among the immunocompetent, is also possible [30][31][32][33]. Tanzania's national immunization program does not include a birth dose of hepatitis B vaccine, but rather a 3-dose regimen beginning at 4 weeks of life in conjunction with other routine vaccinations.…”

Clinical significance of "anti-HBc alone" in human immunodeficiency virus-positive patients

“…HCV replication could produce a down regulation in HBV replication, and this could be expressed as a defective serological pattern [7,18] . I D U h a s a l s o b e e n r e p o r t e d p r e v i o u s l y a s significantly more frequent in the "anti-HBc alone" group [19] and it has been related to a higher frequency of HCV, as IDU is one of the strongest risk factors for HCV infection.…”

What is the best way to manage screening for infections and vaccination of inflammatory bowel disease patients?

“…The discontinuation of immunomodulators should be considered until symptoms of colitis ameliorate or in case of systemic CMV disease. they could represent the only positive test in particular situations, such as the case of immunosuppressed patients or hepatitis C virus (HCV)/human immunodeficiency virus (HIV) co-infections [47] . However, a low rate of false positivity has been described.…”

“…It is safe to administer the standard vaccination protocol to patients with IBD on immunosuppressive medications, but the response may be significantly reduced, and an intensified vaccination protocol may be required. Postvaccination HBsAb titers should be monitored, and, if non-protective (< 10 mU/mL), a booster dose or revaccination should be administered [47] . HBV vaccination seems not to be very common in IBD patients, according to four studies exploring the topic.…”