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Higher-Than-Expected Isolated Hep B Core Antibodies in Philadelphia Screening
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AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston
Mark Mascolini
Prevalence of isolated hepatitis B core antibodies (Anti-HBc) reached 7% in Philadelphia community-based screening, a higher-than-expected level [1]. The finding supports Centers for Disease Control and Prevention (CDC) advice to do triple-panel testing (which includes Anti-HBc) when screening for HBV.
Thomas Jefferson University researchers who conducted this study noted that recent community-based HBV testing in Philadelphia immigrant and high-risk communities found HBV prevalence of 8%. Community-level screening in Philadelphia also uncovered a higher-than-anticipated rate of isolated core antibodies (Anti-HBc). In 2023 the CDC released new hepatitis B screening guidelines that recommend a triple-panel test including hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (Anti-HBs), and antibody to hepatitis B core antigen (Anti-HBc) [2].
At community health fairs in Philadelphia, community-based organizations screened 177 people for HBV with a triple-panel test and assessed these individuals for risk factors. Screeners linked people to care according to their test results. The researchers used Firth logistic regression models to estimate odds of detecting isolated core antibodies.
Thirteen of 177 people (7.3%) screened positive for Anti-HBc while negative for HBsAg and Anti-HBs. Every additional year of age raised odds of Anti-HBc positivity 1.03-fold. People of African origin had 8-fold greater odds of Anti-HBc than people born in the United States (odds ratio 7.93, 95% confidence interval 0.98 to 1028.64). Western Pacific immigrants did not have greater odds of isolated hep B core antibodies. Nor did sex, race, education level, history of HBV vaccination, or family history of HBV affect odds of Anti-HBc.
Interpreting whether HBsAg, Anti-HBc, and Anti-HBs were positive or negative in an individual [see note 3] let researchers determine that 50 screened people were at risk for HBV infection (and should get HBV vaccination), 30 were already vaccinated, 65 were exposed to HBV but had immune control of the virus, 13 had isolated core antibodies, and 12 had current infection.
The Thomas Jefferson team suggested that higher-than-anticipated prevalence of isolated hepatitis B core antigen in African people-especially West Africans-could reflect increased transmission and occult infection in that region. Further work, they added, must determine if a person positive for Anti-HBc is currently infected or recovering from infection.
References
1. Freeland C, Sreepathi V, Hass RW, et al. Screening for isolated hepatitis B core antibodies in greater Philadelphia. AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston.
2. Centers for Disease Control and Prevention. Screening and Testing Recommendations for Chronic Hepatitis B Virus Infection (HBV). 2023. https://www.cdc.gov/hepatitis/hbv/testingchronic.htm
3. At risk for HBV infection: HBsAg (-), Anti-HBs (-), Anti-HBc (-)
Immunized: HBsAg (-), Anti-HBs (+), Anti-HBc (-)
Exposed with immune control: HBsAg (-), Anti-HBs (+), Anti-HBc (+)
Isolated core antibodies: HBsAg (-), Anti-HBs (-), Anti-HBc (+)
Current infection: HBsAg (+), Anti-HBs (+/-), Anti-HBc (+/-)
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