The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample

Catherine Freeland; Vivek Sreepathi; Richard W Hass; Jonathan M Fenkel; Jessie Torgersen; Kenneth Rothstein; Chari Cohen; Robert G Gish

doi:10.1016/j.jve.2023.100358

The importance of triple panel testing for hepatitis B and the burden of isolated anti-hepatitis B core antibodies within a community sample

J Virus Erad. 2023 Dec 11;9(4):100358. doi: 10.1016/j.jve.2023.100358. eCollection 2023 Dec.

Authors

Catherine Freeland¹, Vivek Sreepathi², Richard W Hass², Jonathan M Fenkel³, Jessie Torgersen⁴, Kenneth Rothstein⁴, Chari Cohen¹, Robert G Gish¹

Affiliations

¹ Hepatitis B Foundation, Doylestown, PA, USA.
² Thomas Jefferson University, College of Population Health Science, Philadelphia, PA, USA.
³ Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA.
⁴ University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.

Abstract

Within the United States (US), 2.4 million individuals are living with chronic hepatitis B, but less than 20% are diagnosed. Isolated anti-hepatitis B core (iAHBc) antibodies indicate serology in an individual that is positive for anti-HBc antibodies, while negative for surface antigen (HBsAg) and surface antibodies (anti-HBs). A result of iAHBc could indicate a chronic occult bloodstream infection, necessitating further testing. This study assesses the prevalence and risk factors associated with anti-HBc and iAHBc within community high-risk screening in Greater Philadelphia. Participants (n = 177) were screened for HBsAg, anti-HBs, and anti-HBc during community screening events in 2022. Chi-square tables and Firth logistic regression were used to describe the data and to assess the odds of iAHBc. The findings indicate that there was an iAHBc prevalence of 7.3% (n = 13) within our study. The odds of anti-HBc were increased for immigrants from the Western Pacific (4.5%) and Africa (11.9%). Individuals born in Africa had 7.93 greater odds for iAHBc than those born in the Americas, and these odds are multiplied by 1.01 for every 1-year increase in age. Our data show a high burden of iAHBc within high-risk and often hard-to-reach communities. Triple panel screening should be incorporated into all HBV screening programs, in accordance with current Centers for Disease Control and Prevention (CDC) universal screening recommendations, to ensure a comprehensive picture of the disease burden and reduce the risk of missing people with occult hepatitis B and those at risk for viral reactivation or liver complications.

Keywords: Community health; Hepatitis B; Liver diseases; Public health; Viral hepatitis.