The prevalence of “anti‐HBc alone” and HBV DNA detection among anti‐HBc alone in Korea

Abstract

The "anti-HBc alone" is a frequent serological finding in clinical laboratories, making it difficult to determine whether the HBV infection has resolved. The objectives of this study were to investigate the prevalence of anti-HBc alone and HBV DNA detection (occult HBV infection) among anti-HBc alone, and to describe the demographic and clinical characteristics of anti-HBc alone. A total of 17,677 sera referred from the Health Promotion Center (HPC group, 4,014 sera) as well as all the hospital clinical departments (Patient group, 13,663 sera) were tested for HBs Ag, anti-HBc, and anti-HBs. HBV DNA test using real-time PCR was performed on 230 anti-HBc alone. The prevalence of anti-HBc alone was 8.9%, significantly higher in the Patient group than in the HPC group. The prevalence of anti-HBc was higher in men than women and was increased with age. Very low levels of HBV DNA were found in only 4 (1.7%) out of 230 subjects with anti-HBc alone. They were patients with conditions unrelated to chronic liver disease. Considering the high prevalence of anti-HBc alone, the frequency of occult HBV infection among anti-HBc alone was unexpectedly low. In addition, HBV viral load was low in these patients. Further studies are required to determine the clinical significance and infectivity of anti-HBc alone, in conjunction with very low levels of HBV DNA and to standardize the detection methodology for both anti-HBc alone and HBV DNA.

Infecção oculta pelo vírus da hepatite B em comunidade amazônica submetida a intenso fluxo migratório, estado do Pará, Brasil

“…Um estudo realizado em população coreana saudável, com transaminases normais, que eram VHB e VHC negativos, captou 16,0% de prevalência de IOB 74 . 76 .…”

Prevalence of "anti-HBc alone" among Syrian blood donors

“…Previous reports have shown, however, that HBsAg might not be detected in the serum of infected patients. This can be attributed to chronicity with HBsAg levels below the detection limits [5], HBsAg synthesis downregulation [6], or S gene mutations leading to detection inefficiency [7].…”

“…This "anti-HBc alone" serological profile is frequently observed in HIV-infected individuals, intravenous drug abusers, pregnant women, and patients co-infected with HBV and hepatitis C virus [7]. Albeit inadequately explained, "anti-HBc alone" might represent occult HBV infection in which HBV DNA is present in the liver and/or blood while serum HBsAg is undetectable [6]. Still, it is undervalued locally, as HBsAg is almost the only serological test relied on for blood donation screening, premarital testing, organ transplantation operations, and diagnostic investigations.…”

Hepatitis B Virus DNA is Absent in Lebanese Blood Donors Who Are Positive for Both Anti-Hbc and Anti-Hbs Antibodies

“…Although HBsAg disappearance was long considered as an indication of HBV clearance and infection elimination, nowadays, it is well established that HBsAg might not be detected in the serum of even infected patients (7). This can be explained by either infection chronicity where HBsAg levels are maintained below the detection limit or relative HBsAg synthesis downregulation (8,9). Noteworthy, some HBsAg-negative but anti-HBc-positive individuals, as in the case of OBI (occult hepatitis B infection), are characterized by continuous HBV replication (10,11), indicating that the absence of HBsAg in blood of putatively healthy individuals could not serve as a marker for the absence of circulating HBV.…”