Isolated presence of antibody to hepatitis B core antigen in dialysis patients: occurrence of subclinical hepatitis?
Hepatitis B core antibody (anti-HBc) has recently been recognized as a paradoxical (surrogate) marker for non-A, non-B hepatitis agents in donated blood. We studied prospectively the hepatitis B virus antigen and antibody status and liver functions in 63 uremic patients admitted consecutively to our dialysis program. Nineteen percent of uremic patients, negative for hepatitis B surface antigen (HBsAg), hepatitis B virus surface antibody (anti-HBs), hepatitis B virus DNA, and antibody to delta agents, had anti-HBc in their sera at the time of admission to maintenance dialysis. This prevalence was significantly higher than that of the medical personnel working in the dialysis unit (P = 0.043) and healthy controls (P = 0.027). The prevalence of persistent presence of isolated anti-HBc increased to 31% in these uremic patients on long-term maintenance dialysis. Four patients had developed anti-HBc alone during their course of maintenance dialysis, and the appearance of anti-HBc was preceded by blood transfusion within 4 to 8 weeks. Transient or recurrent hepatic dysfunction occurred in three of these four patients. Patients with isolated anti-HBc were characterized by a higher incidence of repeated liver dysfunction (P less than 0.005), elevated alanine transaminase levels (P less than 0.005), and a higher transfusion requirement (P less than 0.01). Our data strongly suggest that these patients with isolated anti-HBc may have acquired either hepatitis B virus infection or non-A, non-B hepatitis through repeated blood transfusions despite careful screening of the donated blood to exclude transmission of hepatitis B virus.(ABSTRACT TRUNCATED AT 250 WORDS)
Lai
K N
KN
Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Tam
J S
JS
Lai
F M
FM
Lin
H J
HJ
D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006526:Hepatitis C / Q000175:diagnosis* / Q000635:transmission; D006525:Hepatitis, Viral, Human / Q000175:diagnosis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D065227:Transfusion Reaction
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens