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Background Occult Hepatitis B (OHB) is defined as hepatitis B core antibody (HBcAb) positivity in the absence of surface antibody (HBsAb) or surface antigen (HBsAg) positivity. The reported incidence ranges from 0.3% to 58% in the hemodialysis (HD) population. Our study is among the first in the United States to examine the natural history of OHB patients (patients). This work is of interest in HD patients to estimate Hepatitis B transmission risk. Methods We performed a retrospective analysis of 352 Hep B cAb positive HD patients between 2010 and 2017 in the Henry Ford Health System and Greenfield Dialysis Centers in SE Michigan. This system contains 5 hospitals including a 900-bed tertiary referral center in Detroit, serving a high-risk, medically complex population. Our primary outcomes were the development of HBsAb positivity, considered protective, or development of HBsAg positivity or new Hepatitis B viremia, considered adverse events. Univariate and multivariate logistic regression analysis was performed to study pertinent risk factors for the clinical outcomes comparing OHB and Non-OHB patients. Statistical analysis was performed using SAS 9.4. Results Of the 352 HBcAb patients studied, 98 (27%) were OHB patients. Each group shared similar baseline demographics apart from OHB patients having higher ALT and a greater proportion of drug use and Hepatitis C (Hep C) compared with non-OHB patients (Table 1). There were 15 adverse events in the non-OHB group, including 10 viremias. Only 1 adverse event was seen in the OHB group, a patient who developed viremia of 19 copies/mL (Table 2). Conversely, OHB status was a statistically significant predictor of protective HBsAb development in follow-up (P &lt; 0.01), occurring at a 7-fold increased rate compared with non-OHB patients. Univariate analysis showed that a history of liver disease, Hep C, and drug use predicted HBsAb development (Table 3). When studying adverse outcomes, history of liver disease raises the risk of adverse events in unadjusted models (P &lt; 0.05) (Table 4). Conclusion OHB patients in our center tend to develop protective HBsAb titers over time rather than develop viremia or antigenemia in contrast to non-OHB patients. Our study finds that OHB confers minimal risk of potential transmission of Hepatitis B among HD patients. Disclosures All authors: No reported disclosures.

open forum infectious diseases

287. Exploring the Natural History and Clinical Outcomes of Hepatitis B Core Antibody Positive Hemodialysis Patients in a Large Metropolitan Tertiary Care Hospital System with a Focus on Occult Hepatitis B