Atypical Serology Profiles in Hepatitis B Cases: A Retrospective Analysis

Yıl 2025, Cilt: 9 Sayı: 2, 124 - 129, 03.08.2025

Tuğba Bozdemir , Emre Özkarataş , Demet Timur , Uğur Demirpek , Nuray Çalışkan Gürsev

Öz

Aim: Understanding antigen-antibody profiles in hepatitis B virus (HBV) infection is essential for accurate diagnosis and clinical assessment. Although standard serological patterns are well defined, variations in viral protein expression and host immune responses can result in the loss of expected antibodies and the emergence of atypical serological profiles. Such deviations may complicate the interpretation of diagnostic and follow-up testing. This study retrospectively analyzed cases presenting with atypical HBV serological findings.

Methods: Patient data from HBV serology tests conducted at the Microbiology Laboratory of Bursa City Hospital were reviewed from hospital records. Additional tests, including HBV polymerase chain reaction (PCR), hepatitis C virus (HCV) tests (anti-HCV, HCV PCR), and human immunodeficiency virus (HIV) tests (anti-HIV, HIV confirmation), were evaluated in patients with isolated anti-HBc positivity. Patients were categorized on the basis of their HBeAg and anti-HBe status, and the means and standard deviations of the HBV viral load values were calculated.

Results: Atypical HBV serological profiles were identified in 1404 patients (0.49%). The most common atypical profile was isolated anti-HBc positivity, which was observed in 5.27% (n=1079) of the patients. Among 119 the patients tested with HBV PCR, 12 had detectable HBV DNA. Among the 23 patients whose HCV PCR results were tested, 13 had detectable HCV RNA. Three of the 995 patients tested for anti-HIV were reactive, with two confirmed as HIV-1 positive by confirmatory testing.

Conclusion: This study investigated the prevalence and characteristics of atypical HBV serological profiles among patients at Bursa City Hospital. Such profiles may arise due to false reactivity or reflect different stages of infection. Comprehensive evaluation and appropriate clinical management are essential for patients exhibiting these atypical patterns.

Anahtar Kelimeler

Hepatitis B , Serology , Diagnosis

Hepatit B Olgularında Atipik Seroloji Profilleri: Retrospektif Bir Analiz

Öz

Amaç: Hepatit B virüsü (HBV) enfeksiyonu sırasında konakçı tarafından üretilen antijen-antikor profillerinin incelenmesi, enfeksiyon tanısı ve klinik seyrin değerlendirilmesinde önemli yere sahiptir. Serolojik profiller büyük ölçüde tanımlanmış olsa da, viral protein ekspresyonundaki varyasyonlar ve antikor immünojenisitesine bağlı farklılıklar, antikor yanıtında beklenmeyen kayıplara ve alışılmadık serolojik sonuçlara yol açabilmektedir. Bu atipik serolojik profiller tanı ve izlem sırasında enfeksiyonun yorumlanmasında zorluklara yol açabilir. Bu çalışmada, HBV enfeksiyonu yönünden incelenen hastalarda görülen atipik HBV seroloji sonuçlarının retrospektif olarak değerlendirilmesi amaçlanmıştır.

Yöntem: Bursa Şehir Hastanesi Mikrobiyoloji Laboratuvarı'nda çeşitli nedenlerle HBV seroloji testleri araştırılan hastaların sonuçları hastane otomasyon sistemi kayıtlarından retrospektif olarak incelendi. Ayrıca izole anti-HBc pozitifliği olan hastalarda HBV Polimeraz Zincir Reaksiyonu (PCR), Hepatit C virüsü (HCV) testleri (anti-HCV, HCV PCR) ve insan immün yetmezlik virüsü (HIV) testleri (anti-HIV, HIV doğrulama) değerlendirildi. Hastalar HBeAg ve anti-HBe durumlarına göre analiz edildi ve HBV viral yük değerlerinin ortalaması ve standart sapması hesaplandı.

Bulgular: Atipik HBV serolojik profili 1404 (%0.49) hastada tespit edilmiştir. En sık saptanan atipik profil izole anti-HBc pozitifliği (n: 1079, %5.27) olmuştur. Bu gruptaki 119 hastada HBV PCR yapılmış, 12 hastada HBV DNA saptanmıştır. HCV PCR çalışılan 23 hastadan 13’ünde HCV RNA pozitifliği tespit edilmiştir. Anti-HIV testi yapılan 995 hastanın üçü reaktif bulunmuş, bunlardan ikisinin HIV-1 doğrulama testi pozitif sonuçlanmıştır.

Sonuç: Bu çalışma ile Bursa Şehir Hastanesi’ne başvuran hastalarda HBV atipik serolojik profillerinin varlığı ve oranları tespit edilmiştir. Atipik serolojik profiller, yalancı reaktiviteden akut-kronik enfeksiyona kadar farklı durumlardan kaynaklı olabilir. İleri tetkik ve tedavi bu profil saptanan hastalarda önemlidir.

Anahtar Kelimeler

Hepatit B , Seroloji , Tanı

Kaynakça

• 1. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. (Access date: 21.05.2024)
• 2. Li H, Yan L, Shi Y, Lv D, Shang J, Bai L, et al. Hepatitis B Virus Infection: Overview. Adv Exp Med Biol. 2020;1179:1-16. doi: 10.1007/978-981-13-9151-4_1.
• 3. Lee JH, Kim HS. Current laboratory tests for diagnosis of hepatitis B virus infection. Int J Clin Pract. 2021;75(12):e14812. doi: 10.1111/ijcp.14812.
• 4. Zamor PJ, Lane AM. Interpretation of HBV serologies. Clin Liver Dis. 2021;25(4):689-709. doi: 10.1016/j.cld.2021.06.012.
• 5. Ponde RA. Atypical serological profiles in hepatitis B virus infection. Eur J Clin Mikrobiol Infect Dis. 2013;32(4):461-76. doi: 10.1007/s10096-012-1781-9.
• 6. Moretto F, Catherine FX, Esteve C, Blot M, Piroth L. Isolated Anti-HBc: Significance and Management. J Clin Med. 2020;9(1):202. doi: 10.3390/jcm9010202.
• 7. Guvenir M, Arıkan A. Hepatitis B virus: From diagnosis to treatment. Pol J Microbiol. 2020;69(4):391-9. doi: 10.33073/pjm-2020-044.
• 8. Nguyen MH, Wong G, Gane E, Kao JH, Dusheiko G. Hepatitis B virus: Advances in prevention, diagnosis, and therapy. Clin Microbiol Rev. 2020;33(2):e00046-19. doi: 10.1128/cmr.00046-19.
• 9. Aydın N, Kırdar S, Uzun N, Eyigör M, Sayan M. Atypical serological profiles in hepatitis B infections: investigation of S gene mutations in cases with concurrently positive for HBsAg and anti-HBs. Mikrobiyol Bul. 2016;50(4):535-43. doi: 10.5578/mb.32197.
• 10. Chang JJ, Mohtashemi N, Bhattacharya D. Significance and Management of Isolated Hepatitis B Core Antibody (Anti-HBc) in HIV and HCV: Strategies in the DAA Era. Curr HIV/AIDS Rep. 2018;15(2):172-81. doi: 10.1007/s11904-018-0379-y
• 11. Bhattacharya D, Tseng CH, Tate JP, Lo Re V 3rd, Gibert CL, Butt AA, et al. Isolated Hepatitis B Core Antibody is Associated With Advanced Hepatic Fibrosis in HIV/HCV Infection But Not in HIV Infection Alone. J Acquir Immune Defic Syndr. 2016;72(1):e14-7. doi: 10.1097/QAI.0000000000000941
• 12. Grob P, Jilg W, Bornhak H, Gerken G, Gerlich W, Günther S, et al. Serological pattern "anti-HBc alone": report on a workshop. J Med Virol. 2000;62(4):450-5. doi: 10.1002/1096-9071(200012)62:4<450::aid-jmv9>3.0.co;2-y.
• 13. Kang SY, Kim MH, Lee WI. The prevalence of "anti-HBc alone" and HBV DNA detection among anti-HBc alone in Korea. J Med Virol. 2010;82(9):1508-14. doi: 10.1002/jmv.21862.
• 14. Çetinkol Y, Yıldırım AA, Çalgın MK, Altındiş M. Atypical serologies for Hepatitis B; a retrospective review. Turk J Clin Lab. 2015; 6(4):112-5. doi: 10.18663/tjcl.04885.
• 15. Bozdemir T, Türkeş AZ, Sertöz R, Altuğlu İ. Evaluation of 'anti-HBc only' serological pattern detected in patients admitted to Ege University Hospital. Ege Journal of Medicine. 2016;55(4):180-3
• 16. Güngör S. Status of viral hepatitis in Uşak province, Turkey: A 9-year retrospective analysis. Acta Medica Mediterranea. 2021;37:2089-95. doi: 10.19193/0393-6384_2021_4_326.
• 17. Jiang X, Chang L, Yan Y, Wang L. Paradoxical HBsAg and anti-HBs coexistence among chronic HBV infections: Causes and consequences. Int J Biol Sci. 2021;17(4):1125-37. doi: 10.7150/ijbs.55724.
• 18. Wang J, Zhou B, Lai Q, Wang Y, Shen G, Wang Z, et al. Clinical and virological characteristics of chronic hepatitis B with concurrent hepatitis B E antigen and antibody detection. J Viral Hepat. 2011;18(9):646-52. doi: 10.1111/j.1365-2893.2010.01345.x.
• 19. De Almeida Pondé RA. Dynamic profile of the HBeAg-anti-HBe system in acute and chronic hepatitis B virus infection: A clinical-laboratory approach. Mol Biol Rep. 2021;48(1):843-54. doi: 10.1007/s11033-020-06056-4.
• 20. De Almeida Pondé RA. The underlying mechanisms for the "Isolated positivity for the hepatitis B surface antigen (HBsAg)" serological profile. Med Microbiol Immunol. 2011;200(1):13-22. doi: 10.1007/s00430-010-0160-3.
• 21. Aytaç Ö, Toyran A, Aksoy A. The significance and place of HBsAg neutralization test in the diagnosis and algorithm of hepatitis B infection. Mikrobiyol Bul. 2017;51(2):136-44. doi: 10.5578/mb.53835.