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Low antibody HBV core protein levels predict seroclearance

Quantification of antibody against hepatitis B core protein, or anti-HBc levels, significantly predicted HBV surface antigen seroclearance and undetectable HBV DNA in treatment-naive patients with chronic HBV who are HBV e antigen-seronegative, according to a recently published study.

“Although the combination of serum HBV DNA and HBsAg levels is currently used to discriminate HBeAg-seronegative CHB patients from inactive carriers, it has been proposed that anti-HBc level may also distinguish HBeAg-seronegative CHB patients from inactive carriers,” Hui-Han Hu, MD, from the Academia Sinica in Taiwan, and colleagues wrote. “Our data suggests that anti-HBc level can identify inactive carriers with high probability of spontaneous HBsAg clearance.”

Hu and colleagues analyzed the data of 2,500 HBeAg-seronegative patients with chronic HBV. At baseline, 65.4% of patients had HBV levels less than 10⁴ copies/mL, 70.9% had HBsAg levels higher than 10² IU/mL, and 78.8% had anti-HBc levels higher than 3 log IU/mL.

During approximately 8 years of follow-up, the incidence rates of undetectable HBV DNA and HBsAg seroclearance increased as serum anti-HBc levels decreased.

Multivariate analysis showed that anti-HBc levels less than 3 log IU/mL correlated significantly with HBsAg seroclearance (rate ratio = 1.94; 95% CI, 1.46-2.6), especially among patients with HBsAg levels less than 10² IU/mL compared with those with higher anti-HBc levels and HBsAg levels less than 10³ IU/mL (RR = 17.95; 95% CI, 12.49-25.81).

Patients who achieved undetectable HBV DNA also had lower mean anti-HBc levels throughout the study. Among those who achieved HBV DNA, the proportion of patients with anti-HBc levels less than the study median 3.78 log IU/mL increased from 36.4% after 8 years to 67.3% up to 2 years prior to the outcome. In contrast, the proportion of undetectable HBV DNA outcomes decreased from 35.2% after 8 years to 20% up to 2 years prior among those with higher anti-HBc levels.

“This data suggests that a continuous decrease in serum anti-HBc levels during follow-up is important for undetectable HBV DNA and HBsAg seroclearance,” Hu and colleagues concluded. “When combined with HBsAg levels, anti-HBc levels could further stratify patients’ probabilities of achieving both milestones, especially in patients with very low HBsAg levels.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.