Positive anti-HBc linked to cirrhosis, hepatocellular carcinoma in NAFLD

For patients with nonalcoholic fatty liver disease, a positive anti-hepatitis B core antibody was correlated with cirrhosis and hepatocellular carcinoma, according to a study published in the American Journal of Gastroenterology.

“Because a significant proportion of NAFLD-related HCC may develop in noncirrhotic patients, future studies should define the role of anti-HBc in selecting noncirrhotic patients with NAFLD for HCC surveillance,” Ting Ting Chan, MRCP, from the department of Medicine and Therapeutics at The Chinese University of Hong Kong, and colleagues wrote.

Researchers conducted a multicenter study of 489 patients with biopsy-proven NAFLD and 69 patients with NAFLD-related or cryptogenic hepatocellular carcinoma. Previous hepatitis B virus was detected with anti-HBc antibody.

Results showed a positive anti-HBc correlated with a lower steatosis grade but higher fibrosis in the biopsy group. The data showedirrhosis in 18.8% of patients with positive anti-HBc and 7.5% of patients with negative anti-HBc. After adjusting for age and metabolic factors, the correlation between anti-HBc and cirrhosis remained significant (adjusted OR = 2.232; 95% CI, 1.202–4.147). Results also showed a higher incidence of HCC or cirrhotic complications in patients with positive anti-HBC at the mean follow-up of 6.2 years (6.5% vs 2.2%; P = .039). There were 73.9% of patients with NAFLD-related or cryptogenic HCC with positive anti-HBc. No patients had positive serum HBV DNA. Anti-hepatitis B surface antibody was not associated with histological severity.

“Although all of our patients had negative serum HBV DNA, a few reasons may explain the association between anti-HBc positivity and HCC,” the investigators wrote. “First, in all chronic liver diseases, the clinical outcome is determined not only by the current but also past disease activity. Patients with active hepatitis in the past could still accumulate more liver injury with increased risk of HCC. Second, even with negative serum HBV DNA, patients with positive anti-HBc often have detectable HBV DNA and/or covalently closed circular DNA in the liver.” – by Monica Jaramillo

Disclosure: Chan reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.