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Background Few models to predict antiviral response of peginterferon were used in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients and the prediction efficacy was unsatisfied. Quantitative antibody to hepatitis B core antigen (anti-HBc) is a new predictor of treatment response. We aimed to develop a new model to identify HBeAg-positive Chinese patients who were more likely to respond to peginterferon. Methods Data from 140 peginterferon recipients with HBeAg-positive were applied with generalized additive models and multiple logistic regression analysis to develop a baseline scoring system to predict serological response (SR: HBeAg loss and HBeAg seroconversion 24 weeks post-treatment) and combined response (CR: SR plus serum HBV DNA levels Results Anti-HBc levels, alanine aminotransferase ratio, and HBeAg were retained in the final model. The new model scored from 0 to 3. Among patients with scores of 0, 1, or ≥2, SR was achieved in 6.45% (2/31), 13.21% (7/51), and 55.36% (31/56), respectively, and CR in 3.23% (1/31), 9.43% (5/53), and 25.00% (14/56), respectively. Our model has a higher AUROC for SR comparing to Chan’s (Z = 2.77 > 1.96, p < 0.05) and Lampertico’s (Z = 2.06 > 1.96, p < 0.05) model. The negative predictive value for SR and CR were both 100% in patients with score 0 and hepatitis B surface antigen ≥20,000 IU/mL at week 12. Conclusions Patients with higher scores at baseline were more likely to respond to peginterferon. This new model may predict the treatment response.

Background: The prevalence of hepatitis B varies (HBV) among countries. Although an overall reduction has been described in Greece, data are limited. Methods: We reviewed the HBsAg/anti-HBc/anti-HBs seroprevalence among military recruits and compared data between 2005 and 2019. The study included 2001 (group 1) and 1629 (group 2) male recruits in 2019 and 2005, respectively. Age and descent were recorded. Results: The prevalence of HBsAg, anti-HBc and anti-HBs positivity in group1 vs. group 2 was estimated as: 0.2%, 1.3% and 67% vs. 0.4%, 1.6% and 62%, respectively. Only anti-HBs positivity achieved a statistically significant difference between the two groups (p = 0.007). HBsAg and anti-HBc were more frequently positive in non-Greeks than in Greeks (9/237 (4%) vs. 2/3393 (0.06%), p < 0.001), (26/237 (11%) vs. 26/3393 (0.8%), p < 0.001 respectively), while anti-HBs was more frequently positive in Greeks than in non-Greeks (84/164 (51%) vs. 1461/2213 (66%), p < 0.001). Conclusions: Our data suggest a further reduction in HBV prevalence in Greece about 20 years after the adoption of the National HBV Immunization Program, with Greek participants experiencing a more effective HBV Immunization Program than non-Greeks.

Background: Hepatitis B virus (HBV) is a major cause of the liver disease that could lead to acute and chronic inflammation of the liver. In this study we collected anti HBC antibodies (anti hepatitis B core) results done as screening of blood donors from three hospital centers in Lebanon between Jan.2016to Jan.2019. The aim of this study is to collect epidemiological data on the prevalence of positive anti HBC antibodies in blood donors of different nationalities. Method: Blood donation records from the three hospitals were collected from Jan. 2016 till Jan. 2019 and they included 16000 volunteers for blood donation and all these donors were tested for anti HBC antibodies. Results: The total number of donors was 16000, 1224 volunteers (7.65%) had positive anti HBC test. The prevalence of anti HBC antibodies was higher in Syrian population with a prevalence of 12.9% as compared to the Lebanese donors with prevalence of 6.6%. Age was found to have a statistically significant relationship with the prevalence of hepatitis B. blood group was found not to have a statistically significant relationship with hepatitis B.

Background: In the Netherlands, blood donor screening for hepatitis B virus (HBV) consists of HBsAg screening since the 1970s, HBV DNA minipool testing (MP-NAT) since 2008, and anti-HBc screening since 2011. Anti-HBc reactivity causes deferral only if anti-HBs titers are

Background: Now-a-days chronic liver disease is one of the major health problems in the world. In developing countries, chronic liver disease due to hepatitis virus (like hepatitis B and hepatitis C virus) is increasing day by day. It is rapidly emerging as a major health problem. So the present study was conducted to document the hepatitis B and hepatitis C virus in patient with chronic liver disease by an easy and simple marker like HBsAg, Anti HBc (total) and Anti HCV in a tertiary hospital. Methods: Serum samples were collected from 100 selected cases who were diagnosed as a case of chronic liver disease in medicine and gastroenterology department of DMCH. Study period was from April 01, 2016 to September 30, 2018. For detection of HBsAg, Anti HBc (total) and Anti HCV, Immunochromatographic Test (ICT) was done in every case. Results: Out of 100 cases, HBsAg seropositive with negative Anti HCV was found in 64% cases, Anti HCV positive with negative HBsAg was found in 16% cases, both HBsAg and anti HCV positive was found in 4% cases, both HBsAg and anti HCV negative was found in 16% cases. Among these cases, 74% were male and 26% were female. Here male: female was 3:1 and among them, 75% male was seropositive for either HBsAg or Anti HCV. Conclusion: The high frequency of seropositivity in patients with chronic liver disease with male predominance is found in tertiary care settings. The number of Anti HCV seropositive patient indicates that it is an emerging health problem in our country.

Aim: Determine the prevalence of serological markers and identify risk factors associated with Hepatitis B Virus (HBV) infection in patients screened at the Bouake teaching hospital. Study Design: Retrospective cross sectional study was conducted Study Site and Period: Bacteriology-Virology Laboratory/Bouake teaching hospital, Côte d´Ivoire, from April 2016 to January 2018. Methodology: In all 1076 study participants, venous blood sample was collected and screened for HBV surface antigen (HBsAg) and antibody against HBV core antigen (anti-HBc), by electrochemical-luminescence following the manufacturer protocols. Additionally, questionnaires were used to collect information regarding sociodemographic variables and possible risk factors for hepatitis B infection. Data were processed and analyzed using EPI INFO 7 software. Results: A total of 1076 participants were included in this study with a median age of 30.0 years (range: 3 months; 82 years). Of which, 514 (48%) were female and 562 (52%) were male with female / male ratio 1.09. HBsAg was detected in 24,3% of participants and 82 1 (76,3%) were exposed to the risk of HBV infection (anti-HBc positive). High rate of HBV infection was detected in male (27.93%) (p=0.003). The age group of 15–45 years were more infected (27.18%) (p

The aim of the study was to analyze the prevalence and clinical characteristics of HCV/HBV coinfection and to evaluate the rate of HBV-reactivation during anti-HCV therapy in a large real-world study.Analyzed population consisted of 10,152 chronic hepatitis C patients treated with DAA between 2015 and 2019 in a nationwide study. Prior to the DAA all subjects had HBsAg and 60% anti-HBc testing.111 of 10,152 patients (1.1%) had detectable HBsAg and 1239 of 6139 (20.2%) anti-HBcAb. The prevalence of occult hepatitis B was 0.48%. HCV/HBV patients were younger with a higher proportion of males, HIV-coinfected, and advanced fibrosis. They were less often diagnosed with diabetes but more often with chronic kidney disease. In HBsAg(+) subjects with baseline HBV-DNA available 6/102 (5.9%) HBV-reactivations during or after DAA therapy were observed, and in two (1.9%) significant hepatic flares were noted. In HBsAg(-)/anti-HBc(+) group 2 (0.16%) reactivations were observed only in patients undergoing immunosuppressive therapy.Data from a large European cohort suggest a relatively low risk of HBV-reactivation during DAA-therapy for HCV infection in HBsAg(+) patients. In HBsAg(-)/anti-HBc(+) HBV-reactivation seems to be limited to subjects with immunodeficiency. Importantly, previous exposure to HBV and occult hepatitis B is present in a significant proportion of HCV-infected.

The role of novel HBV markers in predicting Hepatitis B virus reactivation (HBV-R) in HBsAg-negative/anti-HBc-positive oncohaematological patients was examined. One hundred and seven HBsAg-negative/anti-HBc-positive oncohaematological patients, receiving anti-HBV prophylaxis for > 18 months were included. At baseline, all patients had undetectable HBV DNA, and 67.3% were anti-HBs positive. HBV-R occurred in 17 (15.9%) patients: 6 during and 11 after the prophylaxis period. At HBV-R, the median (IQR) HBV-DNA was 44 (27–40509) IU/ml, and the alanine aminotransferase upper limit of normal (ULN) was 44% (median [IQR]: 81[49–541] U/L). An anti-HBc>3 cut-off index (COI) plus anti-HBs persistently/declining to 2 time points, also predicts HBV-R (OR [95% CI ]: 13.8 [3.6–52.6]; 50% of positive vs. 7% of negative patients to these markers experienced HBV-R, P=0.001).HS-HBs and anti-HBc titration proved useful early markers of HBV-R.The use of these markers demonstrated that HBV-R frequently occurs in oncohaematological patients with signs of resolved HBV infection, raising issues of proper HBV-R monitoring.

Objectives. – The anti-HBc prevalence over a 14- year period (2004-2017), trends, infectivity, residual risk, and need for testing in blood donors (BD) of the Croatian Institute of Transfusion Medicine were assessed. Material and Methods. – Anti-HBc was tested in 19, 969 BD serum samples collected in 2004 (n=7, 561), 2013 (n=7, 318) and 2017 (n=5, 090). All serums were initially screened for HBsAg, anti-HCV, HIV Ag/Ab, and anti-TP. 2013 and 2017 samples were also tested by ID-NAT. Results. – Over a 14-years period, the anti-HBc prevalence significantly decreased among Croatian BD (5.90% in 2004, 2.56% in 2013, and 1.32% in 2017). Similarly, the prevalence of anti-HBc-only profiles decreased from 0.62% in 2004, 0.25% in 2013, and 0.21% in 2017. The 4-time decreasing trend was observed in all age groups of BD from 2017 but mostly among repeat donors (5.90% to 1.38%). First-time donors showed no significant difference in anti-HBc prevalence probably due to their younger age and HBV vaccine status. However, similar anti-HBs carriage rates (86.4%, 87.6%, and 82.1%) were reported in anti-HBc positive donors over the study period. HBsAg and HBV DNA were not detected. No OBI infection was found in the study despite an OBI frequency of 1:10, 900 donations previously reported in Croatia. A HBV decreasing residual risks of 68, 88, and 12 per million donations were estimated for years 2004, 2013, and 2017, respectively. Conclusion. – Anti-HBc testing is an additional measure of preventing HBV infection by transfusion. Implementation of anti-HBc testing will result in the deferral of 1.3% BD and should be supported by cost-benefit analyses.

The use of hepatitis B core antibody (anti-HBc)-positive grafts is one strategy for expanding the donor pool for liver transplantation (LT). The aim of this study was to determine the risk factors associated with hepatitis B virus (HBV) recurrence after living donor LT (LDLT) of anti-HBc-positive grafts. From January 1996 to December 2018, a total of 609 LDLT procedures were performed at our center. A retrospective review was performed for 31 patients (23 males and 8 females; median age = 47 years) who underwent LDLT for HBV-unrelated liver disease from anti-HBc-positive donors. The factors associated with HBV recurrence were evaluated and compared between the HBV recurrence and non-recurrence groups. The median follow-up period after LT was 135 months (range, 6-273 months). Four of 31 patients (12.9%) developed post-LT HBV recurrence. All four cases were HBV-naïve patients (anti-HBc-negative and Hepatitis B surface antibody-negative). The median interval between LDLT and HBV recurrence was 42 months (range, 20-51). The overall actuarial rates of HBV recurrence at 1, 3, 5, 10, and 20 years were 0%, 7.2%, 15.7%, 15.7%, and 15.7%, respectively. Although there were no significant differences between the HBV recurrence and non-recurrence groups, HBV recurrence tended to occur in HBV-naïve recipients (P = 0.093). HBV-naïve status may contribute to HBV recurrence after LDLT for HBV-unrelated liver disease from anti-HBc-positive donors. Careful monitoring for serological HBV markers is needed, particularly in this group.

Hepatitis B core antibody (Anti HBc) is currently considered the most sensitive serological marker for a patient’s history of hepatitis B virus (HBV) infection given its long-term persistence in the bloodstream. The serological pattern of isolated Anti HBc (IAHBc) has been of clinical interest over the past several years.,Thegrowing data of IAHBcsuggestingit as a marker for occult HBV infection (OBI). Occult HBV infection defined as HBV DNA detection in serum or the liver by sensitive diagnostic tests in HBsAg negative individuals with or without serologic markers of previous viral exposure. OBI is especially concerned in blood transfusion (BT), organ donation and reactivation of HBV infection following immunosuppressive therapy. HBV reactivation depends on viral and host factors. The important clinical implications of IAHBcis in the setting of co-infection with hepatitis C virus (HCV), reactivation risk of HBV during directly acting anti viral (DAA) therapy in HCV infection which may lead to progression of liver disease and hepatocellular carcinoma (HCC). Antiviral prophylaxis has been recommended in moderate to high risk of reactivation prior to immunosuppressive and biologics. The main goal of therapy is to improve survival and quality of life by preventing disease progression and to prevent consequent development of HCC. It is proposed to perform Anti-HBc test as a screening test prior to blood transfusion, HBVvaccination, DAA and immunosuppressive therapy in addition to HBsAg screening test. J Bangladesh Coll Phys Surg 2019; 37(4): 196-201

BACKGROUND The ultimate strategy to cope with transfusion-transmitted hepatitis B virus (HBV) infection caused by transfusion of blood from donors with historical HBV infection is to reject all donors having anti-HBV core antigen (anti-HBc). However, this strategy would result in a huge loss of blood donors and subsequent blood inventory collapse. On the other hand, anti-HBc-positive blood is reportedly not infectious when containing more than 100 mIU/mL of anti-HBV surface antigen (anti-HBs). STUDY DESIGN AND METHODS In Japan, anti-HBc-positive blood has been used for transfusion if it contained 200 mIU/mL or more of anti-HBs. First, to verify the screening policy, clinical outcomes for transfusion of such blood were analyzed for the 2008-2012 period. Second, human hepatocyte-repopulated severe combined immunodeficiency mice were inoculated with HBV preincubated with varying doses of anti-HBs, then viremic status was followed. The effects of anti-HBs across different HBV genotypes were also investigated. RESULTS Twenty-three transfusion-transmitted HBV infections related to anti-HBc-positive blood components were identified. None of the blood responsible for these cases contained 200 mIU/mL or more of anti-HBs. When 100 μL of plasma containing 104 copies of HBV and 20 mIU of anti-HBs was injected into severe combined immunodeficiency mice, no viremia was detected within 13 weeks. Genotype C anti-HBs was capable of total inhibition of genotype A HBV replication, whereas genotype A anti-HBs inhibited genotype C HBV to a lesser extent. CONCLUSION Anti-HBc-positive blood containing 200 mIU/mL or more of anti-HBs appears safe as a transfusion component. HBV vaccination seems effective between HBV genotypes A and C.

BACKGROUND AND OBJECTIVES Antibodies to hepatitis B core antigen (anti-HBc) testing were added to hepatitis surface antigen (HBsAg) screening in Germany in 2006 to prevent hepatitis B virus (HBV) transmissions by chronically infected donors. We report the results of a national surveillance of anti-HBc-reactive and HBsAg-negative donations and assess the resulting gain in blood safety and the donor loss. MATERIALS AND METHODS Donations were tested for anti-HBc, and if reactive, by sensitive individual donation nucleic acid testing (ID-NAT) and for antibodies to HBsAg (anti-HBs). Data from the national anti-HBc surveillance from 2006 to 2015 determined the proportion of anti-HBc-reactive donations stratified for donor type, sex, anti-HBs concentration and NAT-positivity. Donor loss due to anti-HBc-reactive results was quantified. RESULTS Of 31 562 556 donations screened, 70 671 were anti-HBc reactive but HBsAg negative (0.22%). The proportion of repeat donors with these test results decreased significantly from 0.25% in 2007 to 0.08% in 2015. In the entire study period, 82 HBV-NAT-positive donations were identified. Of these, 47 donations were only identified by ID-NAT. A total of 54 203 anti-HBc-reactive units were discarded either due to possible infectiousness (NAT positive or anti-HBs concentration

Background Rituximab is known to be associated with a high resolved hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation in rheumatic patients receiving rituximab is limited. Aims To assess the HBV reactivation in HBsAg-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. Methods From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcomes and factors associated with HBV reactivation were analyzed. Results After a median follow-up period of 3.3 years, 21 patients developed HBV reactivation, among which 17 patients were positive for anti-HBc and 4 were negative. Thirteen patients had clinical hepatitis flare, while 8 patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, and undetectable serum anti-HBs level at rituximab initiation were associated with HBV reactivation. There was no significant difference in the HBV reactivation risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBV reactivation (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). Conclusions In HBV endemic areas, patients with negative anti-HBc, especially those without vaccination at birth, were still at risk for HBV reactivation after receiving rituximab. Regular monitoring of HBV serology should be considered for all HBsAg-negative patients receiving rituximab for autoimmune diseases.

BackgroundMost Chinese Blood Centers adopted mini pool (MP) nucleic acid testing (NAT) for HBV screening due to high cost of Individual donation (ID) NAT, and different proportions of MP-reactive but ID-non-reactive donations (MP+/ID−, defined as non-resolved donations) have been observed during daily donor screening process. Some of these non-resolved donations are occult HBV infections (OBIs), which pose potential risk of HBV transmission if they are not deferred. This study is aimed to further analyze these non-resolved donations.MethodsThe non-resolved plasma samples were further analyzed by serological tests and various HBV DNA amplification assays including quantitative PCR (qPCR) and nested PCR amplifying the basic core and pre-core promoter regions (BCP/PC; 295 base pairs) and HBsAg (S) region (496 base pairs). Molecular characterizations of HBV DNA+ non-resolved samples were determined by sequencing analysis.ResultsOf 17,226 MPs from 103,356 seronegative blood donations, 98 MPs were detected reactive for HBV. Fifty-six out of these 98 (57.1%) reactive MPs were resolved as HBV DNA+, but the remaining 42 pools (42.9%, 252 donations) were left non-resolved with a high rate (53.2%) of anti-HBc+. Surprisingly, among 42 non-resolved MPs, 17 contained one donation identified as OBIs by alternative NAT assays. Sequence analysis on HBV DNAs extracted from these OBI donations showed some key mutations in the S region that may lead to failure in HBsAg detection and vaccine escape.ConclusionA total of 53.2% of the non-resolved donations were anti-HBc+, and OBIs were identified in 40.5% of these non-resolved pools. Therefore, non-resolved donations with anti-HBc+ might pose potential risk for HBV transmission. Our present analysis indicates that anti-HBc testing in non-resolved donations should be used to identify OBIs in order to further increase blood safety in China.

Hepatitis B virus (HBV) reactivation in patients with hematologic malignancies treated with immunosuppressive therapy is a well-known risk. Over 257 million people worldwide are chronic carriers of...

The anti-HBc-positive/HBsAg-negative status is frequent in HIV-infection and correlates with poor survival. Here, by highly-sensitive assays, we evaluate cryptic HBV replication and factors correlated with its detection in 81 anti-HBc-positive/HBsAg-negative HIV-infected patients. Patients were treated for &gt, 12 months with HBV-active modern combined antiretroviral-therapy (cART) and had serum HBV-DNA &lt, 20 IU/mL by commercial Real-Time PCR. Serum HBV-DNA was quantified by droplet digital PCR, serum HBV-RNA by an Abbott research assay, and anti-HBc titer (proposed to infer intrahepatic cccDNA) by Lumipulse/Fujirebio. Cryptic serum HBV-DNA was detected in 29.6% of patients (median (IQR): 4(1&ndash, 15) IU/mL) and serum HBV-RNA in 3.7% of patients despite HBsAg-negativity and HBV-active cART. Notably, cryptic serum HBV-DNA correlated with an advanced CDC-stage (p = 0.01) and a lower anti-HBs titer (p = 0.05), while serum HBV-RNA correlated with lower nadir CD4+ cell-count (p = 0.01). By analyzing serological HBV-markers, the combination of anti-HBs &lt, 50 mIU/mL (indicating lower immune response) plus anti-HBc &gt, 15COI (reflecting higher HBV replicative activity) was predictive of cryptic serum HBV-DNA (OR: 4.7(1.1&ndash, 21.7), p = 0.046, PPV = 62.5%, and NPV = 72%). In conclusion, cryptic HBV-replication (not detected by classical assays) characterizes a conspicuous set of anti-HBc-positive HIV-infected patients despite HBsAg-negativity and HBV-active combined antiretroviral therapy (cART). The integration of classical and novel markers may help identify patients with cryptic HBV-replication, thus optimizing the monitoring of anti-HBc-positive/HBsAg-negative HIV-infected patients.

The long-term persistence of hepatitis B surface antibody (anti-HBs) after hepatitis B vaccination among adults harboring isolated hepatitis B core antibody (anti-HBc) is not yet clarified. The present study aimed to assess the immunogenicity and persistence of antibodies in adults 8 years after vaccination. A total of 309 participants including 94 participants in the isolated anti-HBs group and 215 in the control group were recruited in this study. All subjects received three doses of hepatitis B vaccine (20 μg) at 0, 1, and 12 months, followed by testing for serological responses 1 month after the third vaccination. Subsequently, 154 participants were excluded because their anti-HBs data of 8 y after the first vaccination were missing. The prevalence of isolated anti-HBc was about 11.5%, the positive seroprotection rate was 72%, and the geometric mean titer (GMT) value of anti-HBs titer was 24.55 mIU/mL in the isolated anti-HBc group 8 y after three doses of vaccination. No significant difference was detected in the positive seroprotection rate (P = .434) and the GMT values of anti-HBs titers (P = .674) between the isolated anti-HBc and control groups after 8 y. In conclusion, isolated anti-HBc-positive subjects could achieve satisfactory long-term immune effects after hepatitis B vaccination. The GMT values of anti-HBs titers were lower than those of the control group at 1 month, but no significant difference was detected after 8 years.

Background: Hepatitis B virus (HBV) reactivation can be asymptomatic or manifest as fatal fulminant hepatitis. Most international guidelines recommend screening patients prior to immunosuppressive therapy. Aims: To determine HBV screening rates and modalities in patients receiving chemotherapy at the American University of Beirut Medical Center. Methods: A retrospective cohort review of electronic health records of adult patients who received chemotherapeutic agents, between June 2015 and June 2016. Patients clinical characteristics were documented. Adequate screening was defined as performing all: HBsAg, HBs Abs, and anti HBc Abs(total). Results: A total of 1547 patients were initially assessed. 45.6% were males with a mean age of 56. 382(30%) had hematologic malignancies, of whom 111 underwent HSCT. Of those included, 303(24%) patients were screened by at least one test for HBV and 42(3.3%) for HBsAg, anti HBc Abs and HBs Abs. Patients who were appropriately screened were significantly younger(p=0.008) and more likely to have hematologic malignancies (n=35, 83.3%, p

Rituximab (RTX) has been classified as a drug associated with a high risk for hepatitis B virus (HBV) reactivation in HbsAg-negative/anti-HBc-positive patients. However, data on frequency of HBV reactivation are limited especially for RTX monotherapy. Several new recommendations for screening, monitoring and prophylactic antiviral treatment have been published recently. Here, we report the real-life experience in the management and reactivation rate of HbsAg-negative/anti-HBc-positive patients treated with RTX with or without chemotherapy from a large cohort and discuss our results in the light of updated recommendations.

Purpose: In this study, we analyzed biochemical parameters in the serum of patients with a diagnosis of hepatocellular carcinoma (HCC) C and B viral aetiology. Material/Methods: All patients (31 males and 20 females) with a diagnosis of HCC that were treated at the Clinical Centre of the University of Sarajevo were included in this retrospective-prospective study. Serum alpha-fetoprotein was analyzed as a tumour marker, and hepatitis markers included HBs Ag, anti-HBs, anti-HBc, anti-HCV and anti-HB. Spearman test and Kolmogorov-Smirnov test were used for correlation and normality analysis, respectively. Results: The largest number of patients (68.62%) had cirrhosis of C viral aetiology that developed in cancer. Hepatocellular carcinoma was diagnosed more in men than in women (60.78%). The most patients were middle-aged (41-64 years). HCC was present in the right liver lobe at 82.85% HCV and 87.5% HBV patients. Only 6.25% of HBV patients were both liver lobes affected. All biochemical parameters had very high values, especially AFP and γGT. Significant differences for AST and ALT were found between men and women. Serum bilirubin levels (total, direct and indirect) and AP are higher in men than in women. Hepatitis markers had high values, and the incidence of HBs Ag (78%) and anti-HBc (78.72%) was established. Conclusions: A positive correlation was established between AFP and other parameters, while a significant difference between AFP and γGT (r = 0.372, p = 0.008) was confirmed. In addition to imaging methods for determining liver cirrhosis and hepatocellular carcinoma, high values of AFP and γGT, are a powerful diagnostic marker for these diseases.

Introduction: In Cameroon, blood transfusion safety is a real public health problem. It is one of the African countries where screening for HBsAb is not systematic in blood donors, which can expose the beneficiaries of these donations to possible viral hepatitis B (VHB) infections. Methodology: We carry out a descriptive study at the Yaoundé Central Hospital blood bank during the period from August to October 2018. It was intended to determine the residual risk of transmission of VHB related to the presence of HBcAb in blood donors tested negative to HBsAg. The immunochromatographic technique was used for the detection of total HBcAb in blood donors tested negative for HBsAg, HCV, HIV and TPHA markers. The viral markers, HBsAg, HIV, HCVAb, and TPHA, were tested by ARCHITECT, an apparatus which uses the immunological principle of chemiluminescence. Results: Of the 148 donors registered in the study, we had 129 men and 19 women. We obtained an overall transmission risk of HBV related to the presence of HBcAb of 43.24%. This risk was 47.37% for family donors (p = 0.03999) and 27.3% for volunteers. No significant association was found between the sex of the participants (p = 0.3762), age (p = 0.7403), donor regularity (p = 0.4587) and HBcAb frequency. Concluson: In view of these results, the HBcAb remains very high in the blood donors tested HBsAg negative in Cameroon. To complete this study, we suggest the screening for viral DNA in donors who are tested HBsAg negative and HBcAb positive to eradicate this residual risk of HBV transmission through blood transfusion.

Aim: To assess the predictive value of the Baveno VI criteria for the diagnosis of large esophageal varices (EV) in Black African patient with compensated hepatitis B related cirrhosis. Methods: We carried out a cross-sectional study from January 2 to July 3 (2016), in Department of Gastroenterology at University Hospitals of Cocody (CHUC) and Yopougon (CHUY). All the black African patients included were more than 15 years old and their liver elasticity score (LES) was carried out at Yopougon University Hospital. Hepatitis B related cirrhosis was defined by LES ≥ 11 kPa (FibroScan® (Echosens, France)) with positive HBs antigen (HBsAg) and anti HBc antibody. All the patients with hepatitis B related cirrhosis performed a gastroscopy at Cocody University Hospital and esophageal varices were ranked according to societe francaise d’endoscopie digestive (SFED) classification. Data analysis was performed by SPSS model 20.0 statistics software (SPSS Inc., Chicago, IL, United States). Diagnostic performance of LES 150,000/mmm3 (Baveno VI criteria) for the diagnosis of large EV by gastroscopy was studied (area under the ROC curve, specificity (Sp), sensitivity (Se), positive predictive value (PPV) and negative predictive value (NPV). Results: During the study period, 720 patients achieved liver FibroScan® at CHUY. Of these, 60 respondents to our inclusion criteria were prospectively included in our study. Twelve (20%) of these 60 patients met the Baveno VI criteria. EV were present in 40% of cases (n = 24) with 6.7% (n = 4), 15% (n = 9) and 18.3% (n = 11) of grade 1, 2 and 3, respectively. (66.7% (n = 40) without EV or with small EV) and 33.3% (n = 20) with large EV. The Baveno VI criteria had a Se, Sp, PPV and NPV of 100%, 41.6%, 30% and 100% respectively for the diagnosis of large EV. The area under the ROC curve of a platelet count greater than 150,000/mm3, a liver elasticity score of less than 20 kPa and combination of both were respectively 0.763 [0.645 - 0.880; P = 0.272]; 0.588 [0.436 - 0.739; P = 0.01] and 0.650 [0.513 - 0.787 P = 0.005]. Conclusion: The combination of liver elasticity score 150,000/mm3, allowed the exclusion of large esophageal varices at gastroscopy with a 100 % NPV in Black African patients with compensated hepatitis B related cirrhosis.

Hepatitis B virus (HBV) infection is prevalent worldwide and is associated with dramatic levels of morbidity and mortality. Isolated anti-HBc (IAHBc) is a particular serological pattern that is commonly found in immunocompromised patients. There is ongoing debate regarding the management of patients with IAHBc. Herein, we summarize the current guidelines and the newest evidence. The frequency of IAHBc is variable, with a higher prevalence in some populations, such as persons living with HIV and others immunocompromised patients. The risk of HBV reactivation depends on host factors (including immunosuppression) and viral factors. It is now well established that immunocompromised patients can be classified into three groups for risk according to the type of immunosuppression and/or treatment. In patients at high risk, HBV therapy has to be considered systematically. In patients at moderate risk, the decision is based on the level of HBV DNA (preemptive treatment or monitoring and vaccination). In patients with low risk, HBV vaccination is another possible approach, although further studies are needed to assess the type of preemptive strategy.

Aim of the study To determine the influence of HBsAg and HBeAg negative but anti-HBc positive status on the sustained virological response (SVR) rate in HCV-infected patients treated with pegylated interferon alfa 2 (Peg-IFNα-2) and ribavirin (RBV). Material and methods The study was based on the retrospective analysis of medical records of HCV-infected patients who started Peg-IFNα and RBV treatment between 1 January 2011 and 31 December 2013 at the 1st and 2nd Department of Infectious Diseases of the Regional Hospital in Wroclaw, Poland. Results Among 240 patients included in the analysis 99 were anti-HBc positive and 141 anti-HBc negative. In the genotype 1, anti-HBc positive group the SVR rate was 47% and in the anti-HBc negative group it was 42.7% (p = 0.591). In the genotype 3, anti-HBc positive group the SVR rate was 60% and in anti-HBc negative patients it was 63.2% (p = 0.79). Differences in SVR rates between anti-HBc positive and negative groups were not statistically significant. None of the anti-HBc positive patients developed reactivation of HBV infection during or in the 24 weeks following the end of treatment. Conclusions Anti-HBc determination does not seem to be useful in predicting treatment outcome of conventional Peg-IFNα/RBV therapy in patients infected with HCV genotypes 1 and 3.

BACKGROUD: Low levels or lack of antibodies to the hepatitis B surface antigen (anti-HBsAg, respectively) have been associated with an increased risk of developing an hepatitis B virus (HBV) response in patients with resolved HBV infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Levels of HB core antibodies (anti-HBc) is a new marker associated with the natural history and treatment response of chronic HBV infection. AIMS: This study aims to determine whether different changes in anti-HBc and anti-HBs levels during allo-HSCT can predict the impact of HBV on the survival of patients who underwent allo-HSCT. METHODS: This prospective study enrolled 141 patients who underwent allo-HSCT at the Union Medical College Hospital of Fujian Medical University between 2013 and 2016. The cohort included 65 patients with acute myeloid leukemia, 25 with acute lymphoblastic leukemia, 7 with chronic myeloid leukemia, 15 with aplastic anemia, 5 with lymphoma, and 8 with myelodysplastic syndrome. Based on HBsAg and anti-HBc results, patients were classified as HBsAg-positive (n=16), HBsAg-negative/anti-HBc-positive (n=81), and HBsAg-negative/anti-HBc-negative (n=44). Hepatitis B serological markers (ELISA) and HBV DNA (PCR) were assayed before and every two weeks after HSCT. After transplant, patients received antiviral treatment with a nucleoside analog entecavir given before the transplantation. Antiviral therapy was continued for 1 year after stopping immunosuppressive therapy after transplantation. Death, overall survival (OS), incidence of graft-versus-host disease (GVHD), and drug-induced liver injury were compared among the three groups. RESULTS: The three groups were well matched demographically. All patients achieved successful engraftment within one month post-transplant. There was no difference in time to leukocyte and platelet engraftment in the three groups. Comparing OS between the three groups, the two-year OS was 64.3% vs 53.5% vs 52.4%, respectively, with no significant difference (p=0.866). After allo-HSCT, 22/81 (27.1%) subjects in the HBsAg-negative/anti-HBc-positive group exhibited loss of anti-HBc at the median time 6 months (3-21m). The incidence of acute GVHD (46.9 % versus 40 %, P =0.163) was similar in the loss anti-HBc group (n=22) versus no-loss anti-HBc group (n=59). With a median follow-up time of 588 days (range: 46-1582 days), the incidence of liver injury in the two groups was similar (52.2% versus 46.5% p=0.633). The difference in the post-transplantation cumulative survival rates between the groups with loss of anti-HBc (n=22) and no-loss (n=59) was significant (83.3% versus 43.1%, P =0.001). CONCLUSION: Loss of anti-HBc early in hematopoietic stem cell transplantation may help predict patient outcome. Disclosures No relevant conflicts of interest to declare.

Objectives We assessed the analytical and clinical performance of the Lumipulse® G HBcAb-N (Fujirebio, Japan) assay for IgG antibodies to hepatitis B core antigen (anti-HBc IgG) measurement in serum of subjects with overt and occult HBV infection (OBI). Materials/methods Serum anti-HBc IgG was assessed in 181 anti-HBc-positive subjects: 119 chronic hepatitis B (CHB) patients in different infection phases and 62 subjects (35 CHB and 27 OBI) with available liver specimens for HBV covalently-close-circular (ccc) DNA analysis. Results The anti-HBc IgG assay showed a linear dynamic range (R2 = 0.9967); lower limit of detection and quantitation were 0.5 IU/mL and 0.8 IU/mL. Reproducibility was 4.9% and accuracy 98.7%. Anti-HBc IgG levels varied according to HBV infection phase, linearly declined during antiviral treatment and resulted correlated to intrahepatic HBV cccDNA (r = 0.752, P Conclusions The quantitative anti-HBc IgG assay exhibited appropriate analytical performance and may represent a diagnostic complement in CHB patients and OBI subjects.

Objective: Chemotherapy may lead to HBV re-activation. The aim of this study is to evaluate screening results for HBV infection before chemotherapy, treatment status in patients who are being followed up and planned to receive chemotherapy in our hospital. Patients and Methods: A total of 83 patients who were admitted to Medical Oncology Outpatient Clinic of S.B.Ü. Kanuni Sultan Süleyman Research and Training Hospital between June 2015 and January 2018 and planned to receive chemotherapy were included in the study. Age, diagnoses, HBsAg, anti-HBs, anti-HBc, and HBV-DNA results of the patients were recorded through screening files. Results: When a total of 83 patients who were planned to receive chemotherapy were analyzed with regard to cancer type; breast and ovarian cancers were found to be the most common. HBsAg positivity ratio of our patients was 3.6%, anti-HBs positivity was fund as 38.6%. Ratio of the patients whose anti-HBc was positive when HbsAg, anti-HBs negative was 7.2% (6/83) and HBV-DNA positivity was found in no of these patients. Conclusion: In conclusion, patients should be screened for HBV infection considering risk factors like reactivation, hepatic failure, interruption of chemotherapy; we consider that conducting further studies with larger series would be important.

Background Anti-HBc IgG is almost always detected in hepatitis B virus (HBV)-infected individuals and persists in resolved infections. In certain cases, anti-HBc IgG is the only serological marker and anti-HBc-positive result generally means anti-HBc total positivity. Objectives To evaluate the clinical sensitivity and specificity of an investigational medical device, Elecsys Anti-HBc II, using samples from the Korean population. Agreement between Elecsys Anti-HBc II and its widely utilized predecessor Elecsys Anti-HBc was also evaluated. Study design Residual serum or plasma samples stored at below −20 °C without individual identifiers were used in this study. This study had 106 randomly selected HBV deoxyribonucleic acid (DNA)-positive samples used for evaluating clinical sensitivity. For clinical specificity, a total of 239 both HBV DNA and hepatitis B surface antigen-negative samples, which were anti-HBc-negative by Elecsys Anti-HBc, were used. Agreement between Elecsys Anti-HBc and Elecsys Anti-HBc II was evaluated in total 345 samples. The Architect Anti-HBc II was used as a confirmatory test regarding discrepancies between Elecsys Anti-HBc and Elecsys Anti-HBc II results. Results The clinical sensitivity and specificity of Elecsys Anti-HBc II were found to be 99.06% and 100%, respectively. In total, 345 samples showed 100% agreement. Both positive and negative agreements were also 100%. Conclusions The clinical performance of Elecsys Anti-HBc II was confirmed as sufficient in Korean samples. Elecsys Anti-HBc II demonstrated an exceptional performance, exceeding the requirements of the Ministry of Food and Drug Safety and confirming its reliability as an in vitro diagnostic device for HBV diagnosis in Korea.

From 2007 to 2014, 328 infants born to hepatitis B surface antigen (HBsAg) positive mothers, who received passive-active immunization against hepatitis B at birth were tested for HBsAg, antibody to hepatitis B core antigen (anti-HBc) and antibody to hepatitis B surface antigen (anti-HBs) at 12-15months of age. Thirteen (4%) cases were HBsAg positive. Forty-four infants who were anti-HBs, anti-HBc positive (group 1) and twenty-one infants who were anti-HBc positive alone (group 2) were identified. Both groups were followed-up annually for testing anti-HBs and anti-HBc to verify if anti-HBc was of maternal origin. In group 1, anti-HBc disappeared in 41 cases at month 24, and it disappeared from the remaining 3 cases at month 36. In group 2, anti-HBc disappeared in 18 cases at month 24 and in the remaining 3 cases at month 36. The results show that maternal anti-HBc may persist up to 3years in some children.

To compare the presentations and outcomes of anti-HBc seropositive Hepatocellular Carcinoma (HBc-HCC) with anti-HBc seronegative (NHBc-HCC) patients in HBsAg negative Non-HBV Non-HCV (NBNC-HCC) HCC population.515 newly diagnosed HCC patients from January 2011 to September 2016 were retrospectively reviewed. 145 (66.5%) NHBc-HCC and 73 (33.5%) HBc-HCC patients were identified. Patient demographics, disease characteristics, details of treatments, recurrence and survival outcomes were analysed.A significantly lower proportion of HBc-HCC patients were diagnosed through surveillence (6.8% vs 26.2%, p = 0.001). HBc-HCC patients were less likely cirrhotic (p 0.001), portal hypertensive (p 0.001), ascitic (p = 0.008) and thrombocytopenic (p = 0.003). A higher proportion of HBc-HCC patients had treatment with curative intent (46.6% vs 30.3%, p = 0.018) and surgery (39.7% vs 16.6%, p 0.001). Although HBc-HCC patients had larger median tumor size (74.0 mm vs 55.0 mm, p = 0.016) with a greater proportion of patients having tumors ≥5 cm, there was no difference in the overall median survival (19.0 months vs 22.0 months, p = 0.919) and recurrence rates (38.2% vs 40.9%).Isolated anti-HBc seropositivity in HbsAg negative patients tend to present incidentally with delayed diagnoses resulting in larger tumors, but their long-term survival remain comparable.

Background/Aims: Tumor necrosis factor-? (TNF-?) inhibitors and ustekunimab are widely used in autoimmune diseases. It is known that these biological agents cause the reactivation of hepatitis B virus (HBV). There is no standardized strategy to prevent the reactiva- tion in patients with evidence of a previous HBV infection. In our study, anti-HBc IgG-positive patients who received a biological agent were evaluated in terms of HBV reactivation. Materials and Methods: Patients who were followed up for the use of biological agents in our clinic were evaluated retrospectively. Pa- tients with isolated anti-HBc IgG positivity were included in the study. The HBV reactivation data were recorded from the patients’ files retrospectively. Results: Two hundred and seventy-eight patients who received biological treatment were evaluated. Twenty-nine patients with isolated anti-HBc IgG positivity or resolved HBV infection were included in the study. The HBV reactivation was seen in 5 patients (17.2%). Of these patients, 3 were using adalimumab, 1 infliximab, and 1 ustekunimab. It was controlled by antiviral therapy that was started in the early period. Conclusion: Drugs that block TNF-? and ustekunimab cause an increase in viral replication. In literature, the HBV reactivation rate was approximately 1% in HBsAg-negative, anti-HBC IgG-positive cases, whereas it was found to be as high as 17.2% in our study. Patients receiving the immunomodulator therapy should be evaluated for HBV serology before treatment and carefully monitored for HBV reac- tivation during and after treatment.