Anti-HBc antibodies

The anti-HBc antibody test is a diagnostic test to determine whether the person being tested has been infected with HBV, which causes hepatitis B. It is one of the tests often performed on women expecting a baby or planning a pregnancy. How does the test work and what does the result mean?

Anti-HBc testing - what is it and when is it worth doing?

Anti-HBc antibodies are proteins produced by the human immune system in response to contact with the hepatitis B virus. Cells of the immune system react to the HBc antigen, which is part of the virus core structure.

Testing for the presence of these antibodies makes it possible to detect an existing infection, as it is asymptomatic in a significant proportion of cases.

This examination is particularly recommended for pregnant women and those planning an imminent conception (also by assisted reproduction methods such as in vitro or insemination), due to risk of foetal infection during childbirth. They are also performed in cases of:

  • diagnosis of HBV infection and assessment of subsequent treatment efficacy,
  • risky behaviour that can lead to infection (i.e. casual sexual contact, use of the same needle when injecting psychoactive substances, visits to cosmetic salons and tattoo studios of dubious repute),
  • people belonging to high-risk occupational groups (e.g. medical professions, cosmetologists, salespersons).

No special preparation is needed for the test and can be done at any time of day.

It is worth remembering that the HBc antigen is one of the markers of viral hepatitis, just as HBs antigen[1] . However, it is common to perform both tests when symptoms are present - different combinations of markers allow identification of infection and stage of development.

Hepatitis B virus

Hepatitis B, or hepatitis B, affects more than 250 million people worldwide and around 300,000 Poles[1]This disease, also known as 'inoculative hepatitis', is one of the most dangerous human infectious diseases.

HBV virus (Hepatitis B Virus), after entering the body, leads to the proliferation of viral protein inside the cells of the liver parenchyma, leading to cirrhosis (even in 20% patients within 5 years of infection) or the development of hepatocellular carcinoma.

HBV is up to 100 times more invasive than HIV, and the Infection occurs most frequently[2]:

  • through contact with the patient's blood (both direct and indirect, through non-sterile surgical equipment, needles, etc.),
  • through sexual contact with the patient,
  • through contact with physiological fluids and body secretions (mucus, saliva, sperm),
  • during childbirth (infection can be transmitted from mother to child).

In almost half of those infected, hepatitis B can pass without visible symptomsthat. The only noticeable symptom may be elevated liver markers (ALAT, ASPAT and GGTP). However, a blood test is needed to detect this.

However, some cases of acute hepatitis B may give some, not always specific symptoms[3]:

  • severe muscular-articular pains,
  • general weakness,
  • prolonged sub-febrile state,
  • gastrointestinal complaints - vomiting and nausea,
  • pain in the right lower abdomen.

The above symptoms are usually attributed to other illnesses or chronic fatigue. It is usually only the yellowing of the skin and whites of the eyes and the dark colour of the urine that draws attention to the fact that HBV may be the cause of the general deterioration in health.

In pregnant women, anti-HBc testing should be part of the standard panel of tests for pregnant women. Presence of the virus is not a contraindication to motherhood, but the HBV-infected patient should remain under the care of a specialist infectious disease clinic and the child will receive the vaccine and, in addition, immunoglobulins immediately after birth[4]. This will protect the newborn from infection and consequent health consequences later on.

Anti-HBc antibodies - what does a positive or negative result mean?

Testing for HBc antibodies, also known as anti-HBc total, is a qualitative study, showing only their presence or absence. Therefore, the result of the research can be twofold[5]:

  • anti-HBc negative (non-reactive) - denotes the complete absence of anti-HBc antibodies in the test sample, which is also the standard for the test performed,
  • anti-HBc positive (reactive) - when anti-HBc antibodies are found in the sample. This result is indicative of hepatitis B virus infection.

Anti-HBc tests should go hand in hand and be interpreted together with anti-HBs tests.

In the event of a positive test result, the doctor will usually refer for additional tests to assess the condition of the immune response and monitor changes so that the risk of liver disease can be assessed. Among additional examinations are located[6]:

  • a biochemical blood test, including so-called liver tests (ALAT, ASPAT, GGTP, ALP, bilirubin),
  • serological tests - quantitative tests for the presence of specific HBV antigens (i.e. HBsAg and HBeAG, and antibodies in the IgM and IgG classes),
  • ancillary blood tests (coagulation, ESR, morphology, albumin and total protein levels),
  • imaging and histological tests (abdominal X-ray and ultrasound, liver biopsy).

Anti-HBc test - price

Cost of laboratory tests is dependent on the clinic chosen and the location. At Invimed clinics, an example price for an anti-HBc test is:

  • Warsaw Mokotów - PLN 53,
  • Katowice - PLN 40,
  • Gdynia - PLN 70.

Bibliography:

  1. SALASA, Małgorzata et GOŹDZIALSKA, Anna. Assessment of the state of knowledge regarding the incidence of acute hepatitis B and C among medical personnel. State and Society, 2015, no 3, p. 23-36.
  2. Chmielewska, A. M., Rychłowska, M., Król, E., Solarz, K., & Bieńkowska-Szewczyk, K. (2015). Hepatitis C-new methods of treatment and prevention. Advances in Hygiene & Experimental Medicine/Posteps of Hygiene & Experimental Medicine, 69.
  3. FLISIAK, Robert, HALOTA, Waldemar, JAROSZEWICZ, Jerzy, et al. Recommendations of the Polish HBV Expert Group for the treatment of chronic hepatitis B in 2018. Hepatology, 2018, vol. 18, p. 10-21.
  4. KLAMANN, Janusz et SMIATACZ, Tomasz. Diagnostics of viral hepatitis in general practitioner practice. In : Forum of Family Medicine. 2016. p. 66-72.

[1] SALASA, Małgorzata et GOŹDZIALSKA, Anna. Assessment of the state of knowledge regarding the incidence of acute hepatitis B and C among medical personnel. State and Society, 2015, no 3, p. 23-36.

[2] Chmielewska, A. M., Rychłowska, M., Król, E., Solarz, K., & Bieńkowska-Szewczyk, K. (2015). Hepatitis C-new methods of treatment and prevention. Advances in Hygiene & Experimental Medicine/Posteps of Hygiene & Experimental Medicine, 69.

[3] Chmielewska, A. M., Rychłowska, M., Król, E., Solarz, K., & Bieńkowska-Szewczyk, K. (2015). Hepatitis C-new methods of treatment and prevention. Advances in Hygiene & Experimental Medicine/Posteps of Hygiene & Experimental Medicine, 69.

[4] FLISIAK, Robert, HALOTA, Waldemar, JAROSZEWICZ, Jerzy, et al. Recommendations of the Polish HBV Expert Group for the treatment of chronic hepatitis B in 2018. Hepatology, 2018, vol. 18, p. 10-21.

[5] KLAMANN, Janusz et SMIATACZ, Tomasz. Diagnostics of viral hepatitis in general practitioner practice. In : Forum of Family Medicine. 2016. p. 66-72.

[6] [Ibid].