Isolated antibody to hepatitis B core antigen in blood donors and immune response to hepatitis B vaccination

Association of response to hepatitis B vaccination and survival in dialysis patients

Background

The status of immunocompromised patients is well recognized in end stage renal disease (ESRD). As described recently, this acquired immune dysfunction in the uremic milieu may be one of the main pathogenic factors for mortality in ESRD. The aim of this study was to determine the relationship between the immune response following a hepatitis B vaccination (HBV vaccination) and the survival of maintenance dialysis patients.

Methods

A total of 156 patients (103 on hemodialysis and 53 on continuous ambulatory peritoneal dialysis) were recruited. After receiving a full dose of the HBV vaccination, all patients were followed up for to 5 years to evaluate the association of patient survival, cause of mortality, and immune response.

Results

The response rate to the hepatitis B vaccination was 70.5%. There was no significant association between the immune response and the 5-year survival rate (p =0.600) or between the post-vaccination anti-HBs titers and the 5-year survival rate (p = 0.201). The logistic prediction model with the coefficient as non-response following HBV vaccination, diabetes mellitus, old age, and low albumin level could significantly predict infection-cause mortality (sensitivity = 0.842, specificity = 0.937).

Conclusion

There was no significant association between the immune response to HBV vaccination and the 5-year survival rate. However, non-response following HBV vaccination might be associated with infection-cause mortality in dialysis patients.

Hepatitis B core antibodies in Danish blood donors: a surrogate marker of risk behaviour

BACKGROUND AND OBJECTIVES

The aim of this work was to determine the prevalence of antibodies to hepatitis B core antigen (anti-HBc) among Danish blood donors and to correlate this with risk factors for blood-borne and sexually transmitted diseases.

MATERIALS AND METHODS

During a 5-month period, 10 862 consecutive donors in the County of Funen were screened for anti-HBc, and repeat-reactive samples were confirmed by supplementary testing. Information on risk factors was assessed by questionnaire in 585 consecutive anti-HBc-negative blood donors and compared with information obtained from confirmed positive donors.

RESULTS

The prevalence of confirmed positive anti-HBc among donors was 0.70% (76/10 862, 95% confidence interval [CI]: 0.55-0.87). One donor was positive for anti-HBc immunoglobulin M (IgM); none tested positive for hepatitis B virus (HBV) DNA. In a logistic regression analysis, age, female gender, tattoos and commercial sexual relations, were independent predictive factors for the presence of anti-HBc.

CONCLUSION

Anti-HBc is a surrogate marker for previous risk behaviour in the Danish blood donor population. We suggest that screening for anti-HBc may be used among new donors to supplement interviews on risk behaviour.

Significance of isolated hepatitis B core antibody in blood donors from São Paulo

The clinical significance of isolated anti-HBc is still a challenge. To elucidate the real importance of this finding in our blood donors, an investigation algorithm was tested. One hundred and twelve isolated anti-HBc seropositive blood donors underwent clinical evaluation and retesting of HBV markers. Those who presented repeatedly reactive isolated anti-HBc, received a single dose of hepatitis B recombinant vaccine to verify anti-HBs early response. A HBV-DNA determination by PCR was done for those who did not test positive to anti-HBs after vaccine. The level of anti-HBc was recorded as a ratio of the sample-to-cut-off values (S:C ratio) in 57 candidates at donation. Comparing true and false-positive anti-HBc results, the different S:C ratios of them were statistically significant and when less than 2, implying in a false-positive result probability over 80%. A high percent of false-positive results (16.07%) was verified after anti-HBc retesting. HBV immunity was characterized in 49.11%, either by anti-HBs detection in retesting (15.18%), or after a single dose HBV vaccination (33.93%). HBV-DNA was negative in all tested donors. In conclusion, this algorithm was useful to clarify the meaning of isolated anti-HBc in most of our blood donors.