High levels of serum hepatitis B virus DNA in patients with 'anti-HBc alone': role of HBsAg mutants

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J Viral Hepat. 2011 Oct;18(10):721-729. doi: 10.1111/j.1365-2893.2011.01482.x.

Epub 2011 Jun 30.

High levels of serum hepatitis B virus DNA in patients with 'anti-HBc alone':

role of HBsAg mutants.

Launay O, Masurel J, Servant-Delmas A, Basse-Guérineau AL, Méritet JF,

Laperche S, Sogni P, Rosenberg AR.

Source

Université Paris Descartes, Faculté de Médecine Assistance Publique-Hôpitaux

de Paris, CIC de Vaccinologie Cochin-Pasteur, Groupe Hospitalier Cochin, Pôle

de Médecine Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin,

Service de Virologie Institut National de la Transfusion Sanguine, Centre

National de Référence pour les hépatites B et C en transfusion Université

Paris Descartes, EA 4474 Assistance Publique-Hôpitaux de Paris, Groupe

Hospitalier Cochin, Pôle médico-chirurgical d'Hépato-gastro-entérologie,

Paris, France.

Abstract

Summary.  It remains unclear how the detection of hepatitis B core antibody

(anti-HBc) in the absence of hepatitis B surface antigen (HBsAg) and antibody

(anti-HBs) should be interpreted and whether all patients with this pattern need

to be tested for hepatitis B virus (HBV)-DNA. This study aimed at reassessing

the significance of 'anti-HBc alone' in unselected sera referred to the clinical

laboratory and determining whether significant HBV viraemia can be found in this

setting. Of the 6431 patients tested for HBsAg, total anti-HBc and anti-HBs in a

Paris hospital over a 1-year period, 362 (5.6%) had 'anti-HBc alone' (24.8% of

anti-HBc-positive patients). Only 11 of the 362 sera (3.0%) were found to be

false positive. One patient was in the resolving phase of acute hepatitis B.

HBV-DNA was detected in 10 of 362 (2.8%) patients, using a commercial

standardized assay (threshold: 350 IU/mL). Viral loads exceeded 10(4)

 copies/mL in 6 of 10 patients. Mutations in the HBsAg immunodominant region

were identified in seven of the viraemic patients. HBsAg was detected in only

two cases when retested by one of the latest, multivalent assays. Neither human

immunodeficiency virus nor hepatitis C virus serostatus distinguished between

patients with and without HBV-DNA. In conclusion, 'anti-HBc alone' should be

considered a risk marker for a so-called 'false occult' HBV infection with

significant viraemia. Indeed, results in this hospital population indicate that

a small proportion of patients with 'anti-HBc alone' have high viral loads,

revealing the occurrence of infection with HBV mutants that escape detection

even by multivalent HBsAg assays.

© 2011 Blackwell Publishing Ltd.

PMID: 21914087 [PubMed - as supplied by publisher]