The risk of occult HBV infection in HBcAb-positive general population: a systematic review and meta-analyses

Abstract Background & Aim: Hepatitis B is still a significant public health concern worldwide. The disease burden of occult HBV infection (OBI) has received more widespread attention. Hepatitis B core antibody (HBcAb)-positive is the seromarker of past HBV infection. Whether HBcAb can be used as the surrogate for OBI screening remains controversial. A meta-analysis is performed to evaluate the risk of OBI in HBcAb-positive general population. Method We search published studies in electronic databases which evaluated the prevalence of OBI in HBcAb-positive general population from January 1990 to April 2022, including Pubmed, Web of science, Embase, and Cochrane Library Central through April 18, 2022. The scope of this search was restricted to article published in English. Results Forty-three studies were including in the study, involving 19,777 individuals, 39 (39/43, 91%) original researches with blood detection, and 4 (4/43, 9%) with liver tissue samples. We found the pooled estimated incidences of OBI were 8% (95% CI: 4–13) in HBcAb-positive and 2% (95% CI: 0–4) in HBcAb-negative with blood sample detection, 66% [95% CI: 36–91]) and 0% (95% CI: 0–2) with liver tissue detection, respectively; variable sensitivities and specificities of HBV DNA detection methods were used in different studies. Conclusion The risk of OBI is significantly higher in HBcAb-positive general population than HBcAb-negative. It is necessary to consider HBcAb as a serological surrogate for OBI screening. Establishing standardized and validated confirmation assays for OBI diagnosis are warranted to support the goal of eliminating of HBV infection worldwide.