Hepatitis B Core Antibody: Role in Clinical Practice in 2020
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HEPATITIS B (JK LIM, SECTION EDITOR)
Hepatitis B Core Antibody: Role in Clinical Practice in 2020 Robert G. Gish 1
&
Syed Abdul Basit 2 & John Ryan 2 & Altaf Dawood 3 & Ulrike Protzer 4,5
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review It is crucial for clinicians to understand the need to screen for hepatitis B core antigen (anti-HBc status), proper interpretation of HBV biomarkers, and that “anti-HBc only” indicates HBV exposure, lifelong persistence of cccDNA with incomplete infection control, and potential risk for reactivation. Findings Many common misconceptions exist, including that tests for anti-HBc have high false-positive rates, that patients with anti-HBc alone or occult hepatitis B may profit from “vaccine boosting” to achieve immune control of HBV, and that anti-HBc(+ )/anti-HBs(+) patients have cleared HBV when they have actually achieved immune control, while HBV persists in some hepatocytes and can reactivate. Summary This review breaks down several common misconceptions regarding anti-HBc with the most recent evidence. In addition, current best strategies for anti-HBc testing and interpretation are reviewed and summarized. Keywords Hepatitis B core antibody . Anti-HBc testing . HBV biomarkers . HBV screening . HBV reactivation
Introduction Approximately 2 billion people worldwide have been infected with hepatitis B virus (HBV) as indicated by the presence of antibodies to the hepatitis B core antigen (anti-HBc) [1, 2]. Any indication of necroinflammatory liver disease, either by elevated serum ALT activity or by liver histology in patients who are hepatitis B surface antigen (HBsAg) positive for at least 6 months, is referred to as chronic hepatitis B (CHB) [3]. Historically (before 2002), anti-HBc tests had a high rate of Robert G. Gish and Syed Abdul Basit contributed equally to this work. Robert G. Gish and Syed Abdul Basit are co-first authors This article is part of the Topical Collection on Hepatitis B * Robert G. Gish [email protected] 1
Hepatitis B Foundation, Doylestown, PA, USA
2
Comprehensive Digestive Institute of Nevada, Las Vegas, NV, USA
3
Department of Gastroenterology and Hepatology, University of Nevada School of Medicine, Las Vegas, NV, USA
4
Institute of Virology, Technical University of Munich/Helmholtz Zentrum München, Munich, Germany
5
German Center for Infection Research (DZIF), Munich partner site, Munich, Germany
false positives which led to concerns about lack of vaccine protection or incorrect assessment of patients at risk for reactivation. Fortunately, since 2002, the best anti-HBc tests have a false positive rate of < 2/1000 even in low-risk individuals [4]. One potential scenario where the risk of false-positive testing may be increased is in the setting of intravenous immunoglobulin where passive antibody transfer may lead to false-positive testing before serial testing shows subsequent degradation of core antibodies [5]. To determine a patient’s HBV status, HBsAg is always tested alongside anti-HBc
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