Isolated Anti-HBc: Significance and Management

Abstract

Hepatitis B virus (HBV) infection is prevalent worldwide and is associated with dramatic levels of morbidity and mortality. Isolated anti-HBc (IAHBc) is a particular serological pattern that is commonly found in immunocompromised patients. There is ongoing debate regarding the management of patients with IAHBc. Herein, we summarize the current guidelines and the newest evidence. The frequency of IAHBc is variable, with a higher prevalence in some populations, such as persons living with HIV and others immunocompromised patients. The risk of HBV reactivation depends on host factors (including immunosuppression) and viral factors. It is now well established that immunocompromised patients can be classified into three groups for risk according to the type of immunosuppression and/or treatment. In patients at high risk, HBV therapy has to be considered systematically. In patients at moderate risk, the decision is based on the level of HBV DNA (preemptive treatment or monitoring and vaccination). In patients with low risk, HBV vaccination is another possible approach, although further studies are needed to assess the type of preemptive strategy.

Incidence and Clinical Implications of Isolated Hepatitis B Core Antibody Serologic Profile Pattern Among Egyptian Patients with Chronic Hepatitis C

“…The percentage of incidence of isolated HBc-Ab serologic profile pattern was detected as 22.58 % in such patients. These results agree with Moretto et al, (2020) who declared that the increased prevalence of isolated HBc-Ab is associated with HCV infection (Moretto et al, 2020). Also, these results are slightly agreed with Bhattacharya et al, (2016), who reported the percentage of incidence of isolated HBc-Ab serologic profile pattern as 31 % in HCV-patients coinfected with HIV, they concluded that the higher incidence of isolated HBc-Ab was associated with HCV rather than HIV infection.…”

“…Recent findings refer that the isolated anti-HBc pattern is a serologic profile, which mostly indicates past exposure regarding HBV with lacking the development of HBs-Ab immunity (Moretto et al, 2020). Some studies referred to the association of incidence of such serologic profile with those patients who were particularly exposed to HCV infection.…”

“…Furthermore, the presence of HBs-Ab in the absence of both HBs-Ag and HBc-Ab can refer to immunity due to hepatitis B vaccination. The isolated HBc-Ab serologic profile pattern is defined by the presence of HBc-Ab in the absence of both HBs-Ag and HBs-Ab (Bhattacharya et al, 2016;Moretto et al, 2020). It not only represents a challenge for the interpretation of HBV infection but also confuses the entire management for HBV infection (Chang et al, 2018).…”

“…On the other hand, the viral factors include baseline HBV-DNA, the occurrence of hepatitis D virus (HDV), and non-A genotype of HBV (Borentain et al, 2010;Tohme et al, 2013). This reactivation is characterized by a significant elevation of HBV viral load titre and liver enzymes with severe subsequent complications, which may lead to liver failure and fatality (Karvellas et al, 2017;Moretto et al, 2020).…”

Prevalence of Hepatitis B Virus Markers in Patients with Autoimmune Inflammatory Rheumatic Diseases in Italy

“…Finally, those with serological evidence of resolved infection (anti-HBc-positive/anti-HBs-positive) should receive pre-emptive therapy. Advised NUCs are those at high genetic barrier of resistance (i.e., entecavir or tenofovir) due to the long duration of treatment or prophylaxis [25]; treatment of chronic HBV hepatitis with NUCs should continue until virological response (i.e., HBsAg loss with anti-HBs seroconversion), whereas anti-viral prophylaxis and pre-emptive therapy should continue for at least 12 months (18 months for rituximab) after discontinuation of immunosuppressive treatment [6,26]. The patients herein described have received antiviral therapy or periodical monitoring, based on the serological status and according to the 2012 EASL report [27], and cases of reactivation during immunosuppressive therapy have not yet been observed.…”