Individuals with antibodies against hepatitis B core antigen as the only serological marker for hepatitis B infection: high percentage of carriers of hepatitis B and C virus.
OBJECTIVE
Several reports have unequivocally demonstrated that some individuals with antibodies against hepatitis B core antigen as the only serological marker for hepatitis B infection are chronic carriers of the hepatitis B virus. Nevertheless, conflicting data exist about the frequency of this phenomenon; its cause is unknown.


METHODS
In a prospective study we tested individuals who were positive for anti-HBc alone for HBV-DNA as well as for coexisting infections with human immunodeficiency virus and hepatitis C virus.


RESULTS
Using polymerase chain reaction with primer pairs from three different regions of the hepatitis B virus genome, we found 54 of 164 individuals (32.9%) with anti-HBc alone to be positive for hepatitis B virus, the majority of them showing very low hepatitis B virus concentrations. 14.3% were human immunodeficiency virus positive; half of them were also hepatitis B virus carriers. Surprisingly, 62 of 153 participants (40.5%) in this study showed antibodies against hepatitis C virus, and about two thirds of the latter were also positive for HCV-RNA. This finding could be confirmed by a retrospective analysis of all people tested for hepatitis B virus markers and anti-HCV in our institution during the 2 years before the prospective study was begun. Again, a high correlation was found between the presence of anti-HCV and anti-HBc alone: 49.2% of individuals with anti-HBc only were anti-HCV positive also, compared to 26.8% of HBsAg carriers and only 10% of individuals showing the serological pattern of past hepatitis B.


CONCLUSIONS
Thus our study of individuals positive for anti-HBc alone revealed a high number of carriers of hepatitis B virus and hepatitis C virus among them; furthermore, we found some evidence that hepatitis C virus infection may favour this unusual hepatitis B virus marker pattern.
Max-von-Pettenkofer-Institute for Hygiene and Medical Microbiology, University of Munich, Germany.
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W
Jilg
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Sieger
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Zachoval
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H
Schätzl
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001483:Base Sequence; D015415:Biomarkers / Q000032:analysis; D002353:Carrier State / Q000276:immunology*; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology*; D006509:Hepatitis B / Q000175:diagnosis / Q000276:immunology* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000032:analysis* / Q000235:genetics / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006526:Hepatitis C / Q000276:immunology / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000032:analysis* / Q000235:genetics / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis / Q000235:genetics
D015415:Biomarkers; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral