Question
I saw a patient for evaluation of chronic hepatitis C infection, but he also has total anti-HBc antibody. Does he have both hepatitis B and C?
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Response from Paul Martin, MD Professor of Medicine and Chief, Division of Hepatology, Center for Liver Disease, University of Miami School of Medicine, Miami, Florida |
Clinical Presentation
A 45-year-old man was seen for evaluation of chronic hepatitis C virus (HCV) infection. He had an acute episode of jaundice about 25 years ago, and he made an apparently uneventful recovery. He had briefly experimented with intravenous drug use at that time.
Recently, when he attempted to purchase a life insurance policy, he was denied because of elevated liver chemistries.
On further testing, the patient was found to be seropositive for antibody to HCV with HCV RNA detected by polymerase chain reaction, hepatitis B surface antigen (HBsAg), and surface antibody negative with presence of total hepatitis B core antibody (anti-HBc).
What Is the Diagnosis?
Does this patient have both hepatitis B and C infection?
This patient unequivocally has HCV infection with HCV viremia in addition to the presence of an anti-HCV antibody.
The patient also has a hepatitis B virus (HBV) marker, anti-HBc, present, but, importantly, he has an absence of HBsAg and therefore he does not have continuing HBV infection.
The patient's acute icteric illness many years previously most likely was caused by an acute HBV infection with successful clearance of virus by the host with loss of HBsAg. Not infrequently, anti-HBs decline with time and the only marker of remote HBV infection is a "total" anti-HBc antibody.
With this history and serological profile, it is safe to assume that the patient has immunity to HBV infection as a result of the previous infection and does not require vaccination against HBV, as is recommended for patients with chronic HCV infection. Administration of a single dose of HBV vaccine, although unnecessary with this history, should produce an amnestic response with redevelopment of detectable anti-HBs.