HBsAg-negative patients (hepatitis B surface antigen-negative) and HBcAb-positive (hepatitis B core antibody-positive) may be missed for cirrhosis evaluation in the clinic. Here, the researchers assess the rate of cirrhosis/advanced fibrosis in the United States’ adult population that tests negative for HBsAg but positive for HBcAb. The NHANES data used in this analysis spans the years 2001 through 2018. For this study, investigators enrolled 3,115 adults from the United States who tested positive for HBcAb but negative for HBsAg. Fibrosis-4 (FIB-4) and the aspartate aminotransferase to platelet ratio index (APRI) were used to diagnose cirrhosis. About 45,087 NHANES individuals were tested for HBcAb/HBsAg; of them, 3,115 matched the inclusion criteria (HBcAb-negative/HBsAg-positive with data for FIB-4/APRI). The prevalence of HBsAg-negative/HBcAb-positive adults in the United States was 4.46 percent (95% CI 4.17-4.75) and affected 9.87 million people. The FIB-4 study found that among HBsAg-negative/HBcAb-positive US adults, the weighted prevalence of cirrhosis/advanced fibrosis was 3.76% (95% CI 2.80-4.72%), which translates to 371,112 (95% CI 276,360-465,864) people with cirrhosis. This number was significantly higher among HBsAb-negative (hepatitis B surface antibody) individuals (6.28% When compared with non-APRI results, APRI produced equivalent outcomes. About 3.76% of US adults who tested positive for both HBsAg and HBcAb had cirrhosis/advanced fibrosis, a rate much greater than that of the general US population, according to the FIB-4. Based on their findings, screening for cirrhosis in the HBsAg-negative/HBcAb-positive population was critical to prevent severe liver disease, especially for the HBsAb-negative subset of the population.

Source: link.springer.com/article/10.1007/s40121-022-00680-2