IgM antibody to the hepatitis B core antigen in acute hepatitis determined by SPRIA--diagnostic value

A solid phase radio-immunoassay (SPRIA) was developed for the detection of anti-HBc IgM. The assay proved sensitive and easy to perform and rheumatoid factor did not affect the test results. Anti-HBc IgM titres were followed in consecutive samples from 15 patients after uncomplicated acute hepatitis B. In the acute phase anti-HBc IgM titres ranged from 10(-5) to 10(-7) (mean 10(-6.4)). One year after onset of disease ten of the 15 had titres below 10(-4) and between two and three years after onset most patients had titres 10(-3). Anti-HBc IgM titres were determined in six episodes of acute hepatitis B, all HBsAg negative but anti-HBc positive in the first samples obtained (within 8 days) and developing anti-HBs during convalescence. Acute phase anti-HBc IgM titres in these patients ranged between 10(-5.5) and 10(-7) (mean 10(-6.5)) and were thus identical with HBsAg positive cases. When acute phase sera from 168 episodes of acute hepatitis primarily classified as non-A, non-B, were tested for anti-HBc IgM titres above 10(-5), sera from 13 episodes were positive and in seven of these hepatitis B diagnosis could be confirmed by rising anti-HBs titres in convalescence. Sera from four of the 13 patients contained HBeAg, which was thus demonstrated in the absence of HBsAg. The results show that testing for anti-HBc IgM is important for a true non-A, non-B diagnosis.