Clinical and prognostic values of anti-hepatitis B core immunoglobulin M detection in asymptomatic hepatitis B surface antigen carriers

OBJECTIVE: The aim of this study is to evaluate the clinical and prognostic values of persistence of anti-hepatitis B core immunoglobulin M antibody in asymptomatic adults chronic hepatitis B surface antigen anti-hepatitis Be carriers and its absence in others.

METHODS: Fifty-two hepatitis B surface antigen/anti-hepatitis Be carriers with and 32 without anti-hepatitis B core immunoglobulin M marker were enrolled in this study. The cases were regular attendees of Public Health Laboratory, Virology Center (the main referral center for viral hepatitis) Mosul, North Iraq, for follow-up and clinical evaluation. The study was performed from June 1999 to June 2001. The studied groups consisted of adults, with mean age of 35.5 year (standard deviation +/- 10). The results of histological findings of 23 carriers with and 12 carriers without anti-hepatitis B core immunoglobulin M who underwent liver biopsy were added to the study. Micro enzymed-linked immunosorbent assays was utilized to detect hepatitis B virus markers.

RESULTS: Existence of carrier in the family was significantly associated with persistence of anti-hepatitis B core immunoglobulin M in the studied individuals (p<0.005, odds ratio = 7.4; 95% confidence interval = 1.8 to 38.0), as was the case in the presence of family history of acute hepatitis (p<0.05, odds ratio = 4.6; 95% confidence interval = 4.6 to 21.2). The detection of this antibody was significantly associated with the presence of abnormal liver histology compared to carriers without this antibody (p<0.01, odds ratio = 7.2; 95% confidence interval = 1.8 to 28.7). The study revealed that clustering of carrier cases existed in statistically significant (p<0.001) pattern in family members of carriers with anti-hepatitis B core immunoglobulin M.

CONCLUSION: The detection of anti-hepatitis B core immunoglobulin M clinically is a reminder of recent exposure to the virus through different routes, mainly intrafamilial. Ongoing liver changes are observed in the majority of carriers with this antibody indicating the viral activity, albeit in a silent manner, but earlier progress to serious liver sequels may be inevitable. Foretelling that carriers with anti-hepatitis B core immunoglobulin M are more infectious than carriers without this marker is ascertained by the existence and clustering of carrier cases amongst their family members.