Hepatitis B viral infection status in HCV-endemic areas

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) remain major public health concerns worldwide. While Taiwan has made significant progress in eliminating hepatitis C and promoting hepatitis B vaccination, the interaction between HBV and HCV at the community level and the utility of hepatitis B core-related antigen (HBcrAg) in re-evaluating HBV infection remain unclear at community level. METHODS: A community-based screening was conducted in two townships with high HCV prevalence in Taiwan (2018-2019), enrolling 2000 participants aged ≥ 20 years. Quantitative hepatitis B surface antigen (qHBsAg) and anti-HCV reflex HCV antigen testing were performed. HBcrAg and HBV DNA were assessed in selected HBsAg-negative, anti-HBs-negative, anti-HBc-positive individuals. RESULTS: Overall, HBsAg prevalence followed an inverted U-shaped curve with age, peaking at 40-49 years, while anti-HCV positivity increased progressively with age. HBV vaccination significantly reduced HBsAg carrier rates in the post-vaccination population compared with the pre-vaccination population (3.7% vs. 13.3%, p = 0.004). HBsAg carriage was not significantly associated with either anti-HCV positivity or HCV antigenemia. Among HBV carriers, individuals aged ≥ 65 years showed significantly lower qHBsAg levels. HBcrAg testing found only a few HBsAg-negative individuals with low HBV DNA level, indicating limited viral replication. CONCLUSION: Community-based hepatitis B control strategies may not need to consider regional hepatitis C prevalence. HBcrAg showed limited utility for detecting occult infection in HBsAg-negative individuals. Among individuals aged ≥ 65 years with HBsAg positivity, lower qHBsAg levels were common. suggesting a relatively inactive viral state.