Efficacy and efficiency of hepatitis B core antibody in the diagnosis of occult hepatitis B in hemodialysis patients

Abstract

Background Occult hepatitis B viral infection (OHBI) is defined as hepatitis B virus (HBV) DNA detection in serum by sensitive diagnostic tests in hepatitis B surface antigen (HBsAg) negative patients with or without serological markers of previous viral infection. Aim This study aimed to evaluate hidden infection of hepatitis B among HBsAg negative chronic kidney disease patients on regular hemodialysis (HD) using hepatitis B core antibody as a marker in the sera of these patients, HBV DNA by PCR, and to evaluate the efficacy and efficiency of hepatitis B core antibodies in the diagnosis of occult hepatitis B in HD patients. Patients and methods Eighty chronic kidney disease patients on regular HD were included in this study; the mean age of studied patients was 41.8±12.72 years. They were recruited from HD Unit, Internal Medicine Department, Bab Alshearia University Hospital, Al-Azhar University, Cairo, Egypt, after exclusion of HBsAg positive, HBV antibody positive, intravenous drug users, and alcoholic patients. All patients were subjected to a full assessment of history, blood chemistry, HBsAg by ELISA, hepatitis B core immunoglobulin G (anti-HBcIgG), HB DNA by PCR, hepatitis C antibody (HCV Ab) by ELISA, and abdominal ultrasound. Results Our results showed that HCV Abs were positive in 50% of cases (40 cases); of these patients, 30% (12 cases) were positive for HBcIgG, whereas 50% of the cases (40 cases) were negative for HCV Ab. Of these, 20% (eight cases) were positive for HBcIgG, but the remaining 32 patients were negative for both HCV Abs and HBcIgG. All these results showed negative PCR in all cases (0% of cases). Conclusion OHBI among Egyptian HD patients is low, with a 0% prevalence by PCR; 6 months of repeated PCR is recommended as liver biopsy is difficult in HD patients and HBc Abs are not sufficient for the diagnosis of OHBI in HD patients.