Aim: To investigate the prevalence and clinical significance of "anti-HBc alone" in an unselected population of patients and employees of a university hospital in southern Germany.
Methods: All individuals with the pattern "anti-HBc alone" were registered over a time span of 82 mo. HBV-DNA was measured in serum and liver samples, and clinical charts were reviewed.
Results: Five hundred and fifty two individuals were "anti-HBc alone" (of 3004 anti-HBc positive individuals; 18.4%), and this pattern affected males (20.5%) more often than females (15.3%; P<0.001). HBV-DNA was detected in serum of 44 of 545 "anti-HBc alone" individuals (8.1%), and in paraffin embedded liver tissue in 16 of 39 patients tested (41.0%). There was no association between the detection of HBV genomes and the presence of biochemical, ultrasonic or histological signs of liver damage. Thirty-eight "anti-HBc alone" patients with cirrhosis or primary liver carcinoma had at least one additional risk factor. HCV-coinfection was present in 20.4% of all individuals with "anti-HBc alone" and was the only factor associated with a worse clinical outcome.
Conclusion: In an HBV low prevalence area, no evidence is found that HBV alone causes severe liver damage in individuals with "anti-HBc alone". Recommendations for the management of these individuals are given.