Diagnostic Significance of Anti‐HBcIgM Prevalence Related to Symptoms in Canadian Patients Acutely or Chronically Infected With Hepatitis B Virus

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Abstract
A total of 362 sera from 295 Canadian patients were examined for HBsAg, anti‐HBs, anti‐HBc, anti‐HBcIgM, HBeAg, and anti‐HBe using commercial immunoassays. Serial samples from 70 acutely infected patients demonstrated that anti‐HBcIgM may detect 10% more positives than HBsAg within 4 months after the onset of clinical symptoms, and all except two were negative for anti‐HBcIgM after the fourth month. None of 66 asymptomatic (HBeAg rate 18.2%) and two of 14 (14.3%) symptomatic (HBeAg rate 64.3%) carriers of HBsAg were positive for anti‐HBcIgM (P = 0.029). Elevated marker responses were measured in two symptomatic carriers for a 20‐month period. Anti‐HBcIgM was not detected in either 100 asymptomatic patients positive for total anti‐HBc, negative for HBsAg and negative for or possessing low levels of anti‐HBs, 25 patients with liver disorders not caused by HBV, or 20 healthy milk donors. In diagnostic laboratory practice this anti‐HBcIgM test may be useful in the following situations: to supplement HBsAg testing, providing a theoretical 10% increase in positives within 4 months following onset of acute viral hepatitis; to replace testing for anti‐HBc and anti‐HBs in symptomatic HBsAg‐negative patients; to confirm whether a patient is experiencing acute or chronic HBV infection or symptoms superimposed upon asymptomatic HBsAg carriage by another cause, such as nonA‐nonB viral hepatitis.