Comparison of serum hepatitis B surface antigen (HBsAg) and serum anticore with tissue HBsAg and hepatitis B core antigen (HBcAg)

Abstract

A serological-immunohistochemical comparison study was undertaken in 194 patients (150 with chronic and 44 with acute liver disease). Of 150 with chronic liver disease, 49 patients had one or more of the following markers of hepatitis B virus (HBV); serum hepatitis B surface antigen (HBsAg), antibody to hepatitis B core antigen (anti-HBc), tissue hepatitis B core antigen (HBcAg), and/or tissue HBsAg. Only 36 (73%) were identified as having B viral disease by serum HBsAg alone, whereas simultaneous testing for anti-HBc increased the yield to 47 patients (96%). Of 19 patients, designated as having “cryptogenic cirrhosis” because of negative serum HBsAg and absence of other known etiology, 6 (32%) had HBcAg in tissue and anti-HBc in serum. It would appear that a substantial portion of cryptogenic cirrhosis has its genesis in hepatitis B in the United States. Of all 194 patients, there were 38 patients who had no HBsAg detectable by radioimmunoassay, but had either or both anti-HBc and anti-HBs in serum. Tissue HBcAg was demonstrated in 7 of 7 patients with only anti-HBc in serum and 2 of 5 patients with both anti-HBc and anti-HBs. In sharp contrast, none of 26 patients with only anti-HBs had tissue HBV antigens. These data indicate that in the absence of detectable serum HBsAg or anti-HBs, anti-HBc reflects ongoing HBV infection. At the present levels of sensitivity of the tests, serum analysis for both HBsAg and anti-HBc would have to be used to detect the maximum number of infected and possibly infectious persons.