Hepatitis

Baseline Anti-HBc Level Is Predictive of Spontaneous HBeAg Seroconversion

Avatar photoVirginia A. Schad, PharmD, RPh
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Individuals on PrEP who become infected with HIV, such as those with poor adherence to treatment, may have delayed seroconversion on blood-based and oral-fluid-based rapid antibody tests.2 In one study, oral antibody reactivity was first observed a median of 125 days (range, 14-547 days) after HIV RNA or antibodies were observed in the blood.13 In another study, individuals who received PrEP were 3.49 times more likely than those on placebo to experience a delay of >100 days in detecting the infection.14 Based on these and other findings in the literature, it has been suggested that laboratory-based serum or plasma HIV tests should be used whenever possible to monitor individuals on PrEP.2 Additionally, in the setting of known or suspected poor PrEP adherence, the threshold for augmenting p24/IgM/IgG assays with NAT should be lowered.2

Individuals on PrEP who become infected with HIV, such as those with poor adherence to treatment, may have delayed seroconversion on blood-based and oral-fluid-based rapid antibody tests.2 In one study, oral antibody reactivity was first observed a median of 125 days (range, 14-547 days) after HIV RNA or antibodies were observed in the blood.13


In another study, individuals who received PrEP were 3.49 times more likely than those on placebo to experience a delay of >100 days in detecting the infection.14 Based on these and other findings in the literature, it has been suggested that laboratory-based serum or plasma HIV tests should be used whenever possible to monitor individuals on PrEP.2 Additionally, in the setting of known or suspected poor PrEP adherence, the threshold for augmenting p24/IgM/IgG assays with NAT should be lowered.2

Researchers found data that showed that the baseline hepatitis B core antibody level is indicative of spontaneous hepatitis B e antigen seroconversion in children who were diagnosed as being hepatitis B e antigen-positive, yet untreated, and with normal alanine aminotransferase levels.

The baseline hepatitis B core antibody (anti-HBc) level is predictive of spontaneous hepatitis B e antigen (HBeAg) seroconversion in HBeAg-positive children with a normal alanine aminotransferase (ALT) level, according to a longitudinal study published in Hepatology.1

Anti-HBc is a sensitive marker of hepatitis B virus (HBV) infection, and baseline anti-HBc levels are predictive of HBeAg seroconversion in adults with chronic hepatitis B (CHB) treated with peg-interferon or nucleotide analogues.2-4 While anti-HBc is a biomarker of hepatic inflammation in adults with CHB and a normal ALT level,5 few studies have focused on anti-HBc levels in children and whether baseline anti-HBc levels in HBeAg-positive children with CHB and a normal ALT level is predictive of HBeAg seroconversion. Therefore, researchers investigated the correlation between anti-HBc level and the natural course of CHB infection in children, particularly the ability of the baseline anti-HBc level to predict spontaneous HBeAg seroconversion during long-term follow-up.1 They followed 182 children for a median of 19.8 years and found that spontaneous HBeAg seroconversion occurred in 85 children (46.7%). A baseline anti-HBc titer of >500 IU/mL, HBV genotype B and B+C, and a baseline hepatitis B surface antigen titer of ≤4.8 log10 IU/mL were predictive of spontaneous HBeAg seroconversion. In children that remained HBeAg positive, anti-HBc levels gradually increased because of ongoing inflammation.

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The authors concluded that, “The baseline anti-HBc level is predictive of spontaneous HBeAg seroconversion in HBeAg-positive children with a normal ALT level.”1 They added that, “The anti-HBc level reflects anti-HBV immune response in the HBeAg-positive normal ALT phase of CHB.”


References
1. Chen HS, Wu JF, Su TH, et al. Baseline level of hepatitis B core antibody predicts spontaneous HBeAg seroconversion in HBeAg-positive children with a normal ALT level [published online May 23, 2019]. Hepatology. doi:10.1002/hep.30788.

2. Wu T, Kwok RM, Tran TT. Isolated anti-HBc: the relevance of hepatitis B core antibody – A review of new Issues. Am J Gastroenterol. 2017;112:1780-1788.

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3. Fan R, Sun J, Yuan Q, et al. Baseline quantitative hepatitis B core antibody titre alone strongly predicts HBeAg seroconversion across chronic hepatitis B patients treated with peginterferon or nucleos(t)ide analogues. Gut. 2016;65:313-320.

4. Yuan Q, Song LW, Liu CJ, et al. Quantitative hepatitis B core antibody level may help predict treatment response in chronic hepatitis B patients. Gut. 2013;62:182-184.

5. Zhou J, Song L, Zhao H, et al. Serum hepatitis B core antibody as a biomarker of hepatic inflammation in chronic hepatitis B patients with normal alanine aminotransferase. Sci Rep. 2017;7:2747.

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