Detection of occult hepatitis B virus infection among subjects with isolated hepatitis B core antibodies: Results from a 3-year survey in an Italian tertiary-care hospital

• Published in: Clinics and research in hepatology and gastroenterology Vol. 46; no. 5; p. 101892
• Main Authors: De Conto, Flora, Buttrini, Mirko, Dell'Anna, Maria Loretana, Maccari, Clara, Montanari, Giulia, Arcangeletti, Maria Cristina, Martinelli, Monica, Chezzi, Carlo, Calderaro, Adriana
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.05.2022
• Subjects: Coinfection; DNA, Viral - analysis; Epidemiology; Female; Hepacivirus; Hepatitis B - diagnosis; Hepatitis B - epidemiology; Hepatitis B Antibodies; Hepatitis B Core Antigens; Hepatitis B Surface Antigens; Hepatitis B virus - genetics; Hepatitis B virus DNA; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - diagnosis; Hepatitis B, Chronic - epidemiology; HIV Infections; Humans; Immigrants; Isolated hepatitis B core antigen antibody; Laboratory diagnosis; Male; Occult hepatitis B virus infection; Seroepidemiologic Studies; Tertiary Care Centers; Anti-HBcAg; HIV-1; Anti-HBeAg; HIV-2; HBeAg; Isolated hepatitis B core antigen antibody; HBsAg; Epidemiology; Immigrants; Anti-HBsAg; SD; Occult hepatitis B virus infection; O.R; HIV; OBI; Laboratory diagnosis; HCV; Hepatitis B virus DNA; HBV
• ISSN: 2210-7401; 2210-741X; 2210-741X
• DOI: 10.1016/j.clinre.2022.101892

•In the study population the seroprevalence is 4.6% for HBsAg and 11% for anti-HBcAg.•The isolated anti-HBcAg status shows an age-dependent increase in Italians.•Foreigners with isolated anti-HBcAg came mostly from Africa and Eastern Europe.•HBV DNA assay is scarcely prescribed for subjects with isolated anti-HBcAg status.•Among isolated anti-HBcAg subjects, 14.8% are positive for the prescribed HBV DNA. Hepatitis B virus (HBV) infection causes hepatitis, liver cirrhosis, hepatocellular carcinoma, and death. This study examines the subjects with isolated anti-HBV core antigen antibody (anti-HBcAg), a pattern characterized by the persistent HBV carriage in the absence of HBV surface antigen (HBsAg) and anti-HBsAg antibody. Based on medical orders, from 2017 to 2019, serological and molecular assays were performed on serum/plasma samples of 33,048 subjects (71.4% Italians, 28.6% foreigners), who referred to the Virology Unit of the University-Hospital of Parma (Northern Italy) for the laboratory diagnosis of HBV infection. The seroprevalence was 4.6% for HBsAg and 11% for anti-HBcAg. The occurrence of the isolated anti-HBcAg status was 3.1%, with higher frequency in males than in females (66.3% vs. 33.7%, P < 0.0001), in Italians than in foreigners (54.8% vs. 45.2%, P < 0.001), and in outpatients than in inpatients (57.4% vs. 42.6%, P < 0.0001). Foreigners with isolated anti-HBcAg came mostly from Africa (67.9%) and Eastern Europe (26.2%). Among subjects with isolated anti-HBcAg, 14.8% had occult HBV infection, 26.3% hepatitis C virus co-infection, 2% human immunodeficiency virus co-infection, and 3.3% both of these latter co-infections. The anti-HBcAg assay accurately evaluates the HBV exposure; subjects with isolated anti-HBcAg antibody should be further analysed for HBV DNA. The HBV infection prevalence in Italy is increasing, due to growing migratory flows from endemic areas.