Clinical Diagnostic Value of Quantitative Hepatitis B Virus Core Antibody Test in Chronic Viral Hepatitis B

Abstract

The level of CHB virus (HBV) core antibody (HBcAb) is different in four stages of chronic HBV infection and may be used for differential diagnosis of the natural history of chronic HBV infection. To address this question, we examined multiple blood biomarkers and assessed the efficacy to diagnose different stages of chronic HBV infection. The quantitative detection of HBcAb, hepatitis B surface antigen (HBsAg), HBV DNA, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet count (PLT) were determined in the serum of 73 cases of low-replicative phase (LR), 46 cases of immune-tolerant phase (IT), 44 cases of immune clearance phase (IC), and 57 cases of HBeAg-negative hepatitis (ENH). Differentiating performance of these serum protein levels was analyzed by receiver operating characteristic (ROC) curve analysis. Our results showed that the levels of HBcAb, ALT, and AST levels were significantly higher in IC and ENH than those in LR and IT (both P ≤ 0.001 ). The levels of HBV DNA and HBsAg were higher in IC and IT than those in LR and ENH (both P ≤ 0.001 ). Logistic regression models showed that HBcAb, HBsAg, HBV DNA, ALT, and AST were the independent variables, respectively, and when combined, they provided high diagnostic accuracy for the staging of CHB. To sum up, HBcAb quantification is a new index, which can reflect whether the liver is in the immune activation state of HBV infection, and is related to the inflammatory state of the host liver. The combined detection of HBcAb quantification and other indicators has showed promising efficiency for staging of IC and ENH and can assist the diagnosis and treatment of CHB.

Clinical Utility of Quantitative HBV Core Antibodies for Solving Diagnostic Dilemmas

“…Phase 4 was the one that showed a significantly higher mean level than the other three. The phase with the lowest mean value of anti-HBc was phase 1 in all three studies, unlike a more recent study from 2021, which reported a very similar pattern of anti-HBc variations but with the lowest level in inactive phase 3 [ 29 ]. On the other hand, the latest report showed a considerably different way of anti-HBc level changes through phases of infection [ 26 ].…”

“…The dynamic of HBcAg expression and its secretion in the serum has yet to be entirely clarified. Still, it is speculated that immune cells are exposed to the immunogenic property of this antigen during cell lysis since numerous studies report a simultaneous increase of anti-HBc antibodies with ALT and aspartate aminotransferase (AST) [ 18 , 20 , 27 , 28 , 29 ]. ALT was used as a surrogate marker of the immune response during CHB because ALT levels were associated with T-cell mediated hepatocyte lysis but had poor specificity since it can be affected by drug and alcohol abuse, fatigue and infection with other hepatotropic viruses [ 56 ].…”

“… The significant findings on the clinical utility of qAnti-HBc; * the cut-off values vary significantly among studies, one or two are listed for each diagnostic problem; qAnti-HBc: quantitative HBV core antibodies; CHB: chronic hepatitis B; ACLF: acute-on-chronic liver failure; OBI: occult HBV infection; TACE: transarterial chemoembolisation; HCC: hepatocellular carcinoma; LT: liver transplantation; EOT: end-of-treatment; NA: nucleos(t)ide analogue; IFN: interferon; IU: international units; COI: cut-off index; S/Co: sample/cut-off; References associated with diagnostic problems: Refs. [ 18 , 26 , 27 , 28 , 29 , 30 ] (differentiation of phases of CHB infection), refs. [ 31 , 32 ] (prediction of spontaneous HBeAg seroclearance), refs.…”

Effective Analysis of Antiviral Treatment in Patients with HBeAg-Seropositive Chronic Hepatitis B with ALT < 2 Upper Limits of Normal: A Multi-center Retrospective Cohort Study

“…We acknowledge that ALT is associated with host innate immunity, and elevated ALT may elicit potent host immunity and shows enhanced therapeutic efficacy [ 28 , 29 ]. However, in this study, the normal and mildly elevated ALT groups achieved similar therapeutic outcomes.…”

Research Progress on the Mechanism of Persistent Low-Level HBsAg Expression in the Serum of Patients with Chronic HBV Infection

“…Quantification of HBsAg (qHBsAg) may be helpful for staging HBV infection and predicting its response to antiviral therapy [ 9 ]. According to the results of serology, biochemistry, virology, and other assistant examinations of chronic hepatitis B (CHB) infection, it can be divided into a CHB-carrying state (immune-tolerant phase, IT), inactive HBsAg-carrying state (low-replicative phase, LR), HBeAg- (hepatitis B e antigen-) positive CHB (immune clearance phase, IC), and HBeAg-negative CHB (reactivity period, HBeAg-negative hepatitis, ENH) [ 10 ].…”