Significance of Anti-HBc Screening in Detecting Occult Hepatitis B Infection in Hemodialysis Patients of Resource Limited Settings

Abstract

Introduction: Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) are at increased risk of HBV infection. Occult hepatitis B infection (OBI) is defined by the presence of HBV DNA in the blood or hepatocytes in the absence of detectable hepatitis B surface antigen (HBsAg), with or without anti-HBc antibodies. Persistent OBI may lead to progressive liver damage, including fibrosis, cirrhosis, and hepatocellular carcinoma. Anti-HBc is considered a potential surrogate marker of OBI. This study aimed to determine the prevalence of anti-HBc positivity as a marker of OBI in hemodialysis patients.

Methods: This cross-sectional study included 220 HBsAg-negative patients receiving maintenance hemodialysis in a tertiary care center in Khulna, Bangladesh, for at least for more than 3 months. Anti-HBc antibodies were detected using enzyme-linked immunosorbent assay (ELISA), and qualitative detection of HBV DNA was performed using real-time polymerase chain reaction (PCR). Data were analyzed using SPSS, and a p-value of <0.05 was considered statistically significant. Descriptive and inferential analyses were performed.

Results: A total of 220 patients were included, with a mean age of 47.87 ± 13.46 years; 67% were male. Anti HBc antibodies were detected in 85 (39%) patients, with a mean age of 50.08 ± 12.74 years. Among anti-HBc positive patients, 60 (71%) were male. The HBV DNA was detected in 2 (0.9%) of the HBsAg-negative patients. Both HBV DNA–positive cases were male and anti-HBc positive. On the other hand, no HBV DNA was detected among anti-HBc–negative patients.

Conclusion: The prevalence was low, with only two cases identified. However, a considerable proportion of patients were anti-HBc positive. Anti-HBc may serve as a (pragmatic, low-cost screening tool) important surrogate marker for detecting OBI in hemodialysis patients, particularly in resource-limited settings.

Bang. Renal J. 2026; 8(2): 44-50