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Occult hepatitis B infection (OBI) refers to a condition where replication-competent HBV DNA is present in the liver, with or without HBV DNA in the blood, in individuals with serum HBsAg negativity assessed by currently available assays. The episomal covalently closed circular DNA (cccDNA) in OBI is in a low replicative state. Viral gene expression is mediated by epigenetic control of HBV transcription, including the HBV CpG island methylation pathway and post-translational modification of cccDNA-bound histone, with a different pattern from patients with chronic HBV infection. The prevalence of OBI varies tremendously across patient populations owing to numerous factors, such as geographic location, assay characteristics, host immune response, coinfection with other viruses, and vaccination status. Apart from the risk of viral reactivation upon immunosuppression and the risk of transmission of HBV, OBI has been implicated in hepatocellular carcinoma (HCC) development in patients with chronic HCV infection, those with cryptogenic or known liver disease, and in patients with HBsAg seroclearance after chronic HBV infection. An increasing number of prospective studies and meta-analyses have reported a higher incidence of HCC in patients with HCV and OBI, as well as more advanced tumour histological grades and earlier age of HCC diagnosis, compared with patients without OBI. The proposed pathogenetic mechanisms of OBI-related HCC include the influence of HBV DNA integration on the hepatocyte cell cycle, the production of pro-oncogenic proteins (HBx protein and mutated surface proteins), and persistent low-grade necroinflammation (contributing to the development of fibrosis and cirrhosis). There remain uncertainties about exactly how, and in what order, these mechanisms drive the development of tumours in patients with OBI. [ABSTRACT FROM AUTHOR]

Anti-HBc screening and nucleic acid testing for hepatitis B viral DNA (HBV DNA) detection in blood donors are not routinely performed in clinical settings in Nigeria. This raises serious concerns for safety of blood at a time that global health standards advocate for transfusion safety. The aim of this research is to investigate if presence of anti-HBc in blood donors is actually associated with occult hepatitis B infection through basic and advanced procedures. Prospective blood donors who were seronegative for HBsAg but sero-positive for anti-HBc (with or without other markers) among the four hundred and seventy enrolled in a cross-sectional study were selected for this study. Samples were further screened for hepatitis B core immunoglobulin M by enzyme-linked immunosorbent assay. Nucleic acid testing was performed for confirmation of occult hepatitis B infection. Anti-HBc was detected in 20 (32.8%) of the sixty-one HBsAg antigen-negative blood donors which constituted 13.0% of the total number of enrolled blood donors. Anti-HBc total-positive differentiation showed eighteen (90.0%) anti-HBc (IgG) and two (10%) anti-HBc (IgM) were detected. Nucleic acid testing showed 5.0% prevalence of occult hepatitis B infection among the anti- HBc-positive blood donors with estimated HBV DNA viral load of 58 IU/ml. Demonstration of 5.0% occult hepatitis B prevalence showed the possibility of post-transfusion hepatitis B infection in transfusion recipients with consequent possible liver damage should hepatitis B surface antigen alone be the continued practice in clinical settings. The inclusion of antibody to hepatitis B core antigen screening in addition to hepatitis B surface antigen marker is an essential step to ensuring optimal blood safety and prevent post-transfusion hepatitis. Key words: anti-HBc, isolated, Occult hepatitis B, risk factor, seropositivity. [ABSTRACT FROM AUTHOR]

Occult hepatitis B (OBI) is a major challenging clinical entity characterized by the absence of hepatitis B surface antigen (HBsAg). The persistence of OBI may progress to fibrosis, cirrhosis, and hepatocellular carcinoma. This study was aimed to investigate the prevalence of OBI among HD patients. In the present cross-sectional study, 89 sera samples of hemodialysis individuals were tested for HBsAg and HBc- IgG by Enzyme-linked Immunosorbent Assay (ELISA). In addition, the HBV DNA has tested in sera and peripheral blood mononuclear cell (PBMC) samples by nested-PCR. Out of 89 patients, 51(57.3%) were males, and 38 (42.7%) females. The ages ranged from 24 to 90 years (with a mean of 57.5±1.37 years). All the sera samples had normal levels of Aspartate Aminotransferase (AST) and Alanine Transaminase (ALT) but had high levels of Creatinine (Cr) (6.9±2.17) and Blood Urea Nitrogen (BUN) (61.83±2.03). 2/89 (2.2%) sera samples were positive for both HBsAg and HBc-IgG test; in addition, HBV DNA was detected in both sera and their PBMC samples. The sera of 15/89 (16.85%) were only positive for the HBc-IgG test, including 10/51 (19.6%) males and 5/38 (13.2%) females (P=0.5). The high 16.85% prevalence OBI has been found among HD patients. To manage OBI infection, screening of HBV DNA should be implemented for HD patients by sensitive molecular means such as nested-PCR and real-time PCR. [ABSTRACT FROM AUTHOR]

Copyright of Viral Hepatitis Journal / Viral Hepatit Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Gaps remain in the detection of nucleic acid test (NAT) yield and occult hepatitis B virus (HBV) infection (OBI) by current HBV surface antigen (HBsAg) assays. The lack of detection may be due to HBsAg levels below current assay detection limits, mutations affecting HBsAg assays or HBsAg levels, or the masking of HBsAg by antibody to HBsAg (anti-HBs). In this study, we evaluate the incremental detection of NAT yield and OBI from five diverse geographic areas by an improved sensitivity HBsAg assay and characterize the samples relative to the viral load, anti-HBs status, and PreS1–S2–S mutations. Included is a comparison population with HBV DNA levels comparable to OBI, but with readily detectable HBsAg (High Surface–Low DNA, HSLD). Methods: A total of 347 samples collected from the USA, South Africa, Spain, Cameroon, Vietnam, and Cote D’Ivoire representing NAT yield (HBsAg(−), antibody to HBV core antigen (anti-HBc)(−), HBV DNA(+), N = 131), OBI (HBsAg(−), anti-HBc(+), HBV DNA(+), N = 188), and HSLD (HBsAg(+), anti-HBc(+), HBV DNA(+), N = 28) were tested with ARCHITECT HBsAg NEXT (HBsAgNx) (sensitivity 0.005 IU/mL). The sequencing of the PreS1–S2–S genes from a subset of 177 samples was performed to determine the genotype and assess amino acid variability, particularly in anti-HBs(+) samples. Results: HBsAgNx detected 44/131 (33.6%) NAT yield and 42/188 (22.3%) OBI samples. Mean HBV DNA levels for NAT yield and OBI samples were lower in HBsAgNx(−) (50.3 and 25.9 IU/mL) than in HBsAgNx(+) samples (384.1 and 139.5 IU/mL). Anti-HBs ≥ 10 mIU/mL was present in 28.6% HBsAgNx(+) and 45.2% HBsAgNx(−) OBI, and in 3.6% HSLD samples. The genotypes were A1, A2, B, C, D, E, F, and H. There was no significant difference between HBsAgNx(−) and HBsAgNx(+) in the proportion of samples harboring substitutions or in the mean number of substitutions per sample in PreS1, PreS2, or S for the NAT yield or OBI (p range: 0.1231 to >0.9999). A total of 21/27 (77.8%) of HBsAgNx(+) OBI carried S escape mutations, insertions, or stop codons. HSLD had more PreS1 and fewer S substitutions compared to both HBsAgNx(−) and HBsAgNx(+) OBI. Mutations/deletions associated with impaired HBsAg secretion were observed in the OBI group. Conclusions: HBsAgNx provides the improved detection of NAT yield and OBI samples. Samples that remain undetected by HBsAgNx have exceptionally low HBsAg levels below the assay detection limit, likely due to low viremia or the suppression of HBsAg expression by host and viral factors.

Occult hepatitis B infection (OHB) is not rare in countries that are endemic for hepatitis B virus (HBV) and in patients with chronic hepatitis C virus (HCV) infection. Notably, OHB has been shown to play a role in the progression of liver diseases, including the development of hepatocellular carcinoma (HCC); however, the data is inconsistent. We aim to clarify the contribution of concurrent OHB to the progression of liver diseases in a long-term cohort of patients with HCV infection and to investigate the value of total anti-hepatitis B core (anti-HBc) antibody as a surrogate OHB biomarker. Methods: We included 250 chronic anti-HCV-positive patients who had resolved HBV infection (anti-HBc positive and hepatitis B surface antigen negative). OHB was then detected using a sensitive commercial assay for serum HBV DNA with a low limit of detection of 6 IU/mL. Clinical outcomes, including the development of liver cirrhosis, HCC, and all-cause deaths, were compared between OHB-positive and OHB-negative patients. Results: At baseline, only 183 (73.20%) patients had positive HCV ribonucleic acid, and 56 (30.60%) of these 183 patients with active HCV infection had OHB. The presence of OHB did not correlate with any adverse clinical outcome in multivariate analyses. In addition, chronic hepatitis C patients with OHB did not have a higher level of serum total anti-HBc. Conclusion: OHB infection may not contribute to the development of adverse liver outcomes in patients with chronic HCV.

Background: Hepatitis B Virus (HBV), and occult Hepatitis B in particular, is a major concern in the transfusion scenario, especially in endemic countries. This study attempted to estimate the prevalence of occult Hepatitis B infection (OBI) among voluntary blood donors in Maharashtra and to evaluate the role of combined screening strategy with implications in minimizing the current transfusion risks of seropositive OBI., Methods: Donor samples were collected from 80 eligible blood banks from various districts of Maharashtra between 2014 and 2017. ELISA based screening of HBsAg, anti-HBc (total and IgM), anti-HBs titres. Real-time quantitative PCR for Hepatitis B Virus DNA (HBV DNA) were performed for all HBsAg and or anti-HBc positive samples., Results: Out of 2398 samples tested, 20 (0.83%) samples were positive for HBsAg, whereas 547 (22.81%) were positive for anti-HBc. Out of 547 samples, 16 (2.92%) were positive for HBV DNA with median level at 247.89 IU/mL (IQR: 126.05-666.67 IU/mL). Anti-HBs levels were positive in 35.83% of OBI cases. ROC curve analysis showed that combined HBsAg, anti-HBc and anti-HBs (>50 mIU/mL) screening can more efficiently detect HBV infection in blood donors than HBsAg alone., Conclusions: A combined HBsAg, anti-HBc and anti-HBs screening for donor samples could be an alternative achievable strategy to minimize the HBV transmission as well as financial burden. In resource limited setup, the proposed combined strategy could be helpful in minimizing the risk of OBI transmission., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Dr Aruna Shankarkumar reports financial support was provided by National Health Mission, Maharashtra. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Introduction and Objectives: Occult HBV infection (OBI) is a specific form of hepatitis B virus (HBV) infection and has the possibility of developing into hepatocellular carcinoma (HCC) in adults. This study aimed to estimate the global prevalence of occult HBV infection in children and adolescents., Materials and Methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane databases for relevant studies on the prevalence of OBI in children and adolescents. Meta-analysis was performed using STATA 16 software., Results: Fifty studies were included. The overall prevalence of OBI in children and adolescents was 7.5% (95% CI: 0.050-0.103). In different risk populations, OBI prevalence was remarkably high in the HIV-infected population (24.2%, 95% CI: 0.000-0.788). The OBI prevalence was 0.8% (95% CI:0.000-0.029) in the healthy population, 3.8% (95% CI:0.012-0.074) in the general population, and 6.4% (95% CI: 0.021-0.124) in children born to HBsAg-positive mothers. Based on different serological profiles, the prevalence of OBI in HBsAg-negative and anti-HBc-positive patients was 6.6% (95% CI: 0.016-0.136), 3.0% (95% CI: 0.009-0.059) in HBsAg-negative and anti-HBc-negative patients, 4.6% (95% CI: 0.015-0.088) in HBsAg-negative and anti-HBs-positive patients, and 3.7% (95% CI: 0.001-0.102) in HBsAg-negative and anti-HBs-negative patients., Conclusions: Despite HBV vaccination and hepatitis B immunoglobulin (HBIG), OBI is common in children and adolescents in high-risk groups., Competing Interests: Declaration of interests None., (Copyright © 2023 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: Occult hepatitis B (OHB) is defined as identification of hepatitis B virus (HBV) genome in the liver and/or in the serum of HBsAg-negative individuals. We aimed to identify the situation of OHB in persons with chronic HBV infection among family members. Methods: 327 individuals (ages18 and above) who were referred to Infectious Diseases and Clinical Microbiology Outpatient Clinic between 2015 and 2016, and found as HBsAg-negative but learned the presence of chronic HBV infection among their family members (mother, father, spouse, sibling and offspring) were included in the study. HBsAg, anti-HBs and anti-HBc IgG tests were performed by ELISA, and HBV DNA levels were studied by real time polymerase chain reaction (PCR) in the sera. Results: Of the 327 persons included in the study, 168 (51.4%) were female and 159 (48.6%) were male. Only 6 (%1.8) had HBV DNA positivity. Anti-HBc IgG was positive in 110 (33.6%) and anti-HBs in 193 (59%) persons. Of the individuals whose relatives were evaluated; chronic HBV infection was found in 53 (16.2%) mothers, 60 (18.3%) fathers, 84 (25.7%) siblings, 103 (31.5%) spouses, 14 (4.3%) offsprings and in 13 (4.0%) individuals whose combinations consisted of more than one family member. Of the six cases with positive HBV DNA, 3 had spouses with a history of hepatitis B and in 3 cases, a father, brother and offspring had a history of hepatitis B. Conclusions: It is concluded that intrafamilial OHB screening is not required in family members due to the low incidence of OHB and high cost of HBV DNA testing. Considering both community health and cost, it is more appropriate to give family members the necessary education about HBV transmission paths, clinical importance and how to take measures instead of screening to prevent the emergence of new cases. [ABSTRACT FROM AUTHOR]

Occult hepatitis B virus infection (OBI) is one of the most challenging entities in the field of viral hepatitis. The virological and clinical relevance of OBI in patients treated with novel direct-acting antivirals (DAA) for hepatitisCvirus (HCV) infections is currently a topic of hot debate. In cases where hepatitis B surface antigen (HBsAg) is not detected, DAA treatment is often initiated without examining for the presence of hepatitis B virus (HBV) DNA. In this study, the incidence of OBI was investigated in 114 HCV patients prior to application of DAAswhodid not respond to pegylated interferon and ribavirin (PEG-INF and RBV) treatment. Serum samples were screened for HBV serological markers (antibody to hepatitis B core antigen [anti-HBc] and HBsAg). Samples positive for anti-HBc without HBsAg were further examined via real-time PCR (qPCR), nested PCR and S-gene mutational analyses. Overall, anti-HBc was detected in 37.7% chronic HCV patients and 2.6% had OBI with a baseline HBV DNA viral load < 2000 IU/mL before DAA therapy. Onepatient was identified asHBVgenotype A1 without mutations in surface protein. Our collective data highlight the importance of clinicians being aware of potential anti-HBc positivity in patients with hepatitis C and the issues surrounding OBI screening before initiation of treatment with novel DAAs. [ABSTRACT FROM AUTHOR]

Copyright of Viral Hepatitis Journal / Viral Hepatit Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review of the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts. [ABSTRACT FROM AUTHOR]

Purpose: The frequency of occult hepatitis B is variable in patients with cryptogenic cirrhosis and is unknown in our region. The presence of HBV DNA in serum of cirrhotic patients can be determined by molecular techniques despite the lack HBV serological markers. We aimed to determine the frequency of occult hepatitis B virus in patients with cryptogenic cirrhosis in this study. Materials and Methods: This cross-sectional study was designed to assess the prevalence of occult HBV infection in a group of patients with cryptogenic liver cirrhosis. Forty-four patients with cryptogenic cirrhosis who were examined in our hospital were enrolled in this study. Their serum were studied for HBV DNA levels using a real-time PCR method. Results: There were 44 patients in the study group; Positive for anti-hepatitis B surface antibody was detected in 22 patients, and positive for hepatitis B core antibody was detected in 24 patients. In 2 patients, HBV DNA was found to be positive. In our study, occult HBV infection was found in 4.5% (2/44) of patients with cryptogenic cirrhosis. Conclusion: The prevalence of occult HBV infection was relatively high in patients with cryptogenic cirrhosis; Occult hepatitis B infection may thus play a role in the development of decompensated cirrhosis and complications in cases of cryptogenic liver disease. [ABSTRACT FROM AUTHOR]

• Gaps remain in detection of early acute, late acute, and occult HBV infection. • A new Abbott ARCHITECT/Alinity HBsAg assay improves detection of HBV infection. • The new assay improved detection of early acute HBV by 36.4%. • The new assay detected late acute HBV infection longer than current assays. • The new HBsAg assay increased detection of occult HBV by 10.9%. Hepatitis B surface antigen (HBsAg) is the primary marker for diagnosis of acute and chronic hepatitis B. Although HBsAg assays have undergone continuous improvement, gaps remain in the detection of early and late acute infection and occult hepatitis B infection (OBI). The performance of a prototype, improved sensitivity HBsAg assay run on the ARCHITECT and Alinity instruments was evaluated for detection of early and late acute infection and OBI. Seventy seven early acute samples [positive only for hepatitis B viral DNA (HBV DNA)], twelve seroconversion panels spanning late acute infection, and 101 occult samples (HBsAg negative, positive for HBV DNA and anti-HBc) were tested with the prototype assay and ARCHITECT HBsAg Qualitative II. HBsAg gene sequencing was performed to determine genotype and mutations in the immunodominant region. Compared with ARCHITECT HBsAg Qualitative II, the prototype assay showed increased detection of NAT yield samples (28/77, 36.4%,), late acute samples (≥13 days longer detection of HBsAg for 6/12 panels), and OBI samples (11/101, 10.9%). HBsAg sequence data were obtained for 62 samples. Genotypes represented were A1, A2, B2, B4, C1, C2, C5, D3, E, and H. HBsAg escape mutations were found in 4.8% of NAT yield and 38.9% of OBI samples sequenced. Prototype assay values for 188 samples were equivalent on the ARCHITECT and Alinity instruments. The new prototype HBsAg assay will be of diagnostic value in providing improved detection of early acute, late acute, and occult HBV infections. [ABSTRACT FROM AUTHOR]

Introduction: The hepatitis B virus (HBV) is one health problem in Iran. Occult hepatitis B (OBI) is diagnosed by the detection of HBV DNA in the serum or liver tissue of patients for whom other serology, especially HBsAg and HBcAg, are negative. The current study aimed to determine the prevalence of OBI in patients who refer for chemotherapy. Methods: All patients referring for chemotherapy to the oncology clinic of Baqiyatallah Hospital in Tehran, Iran from 2012 to 2013 were selected as the population of this cross-sectional study. Samples of 5 mL of blood were taken from each subject and assayed for HBsAg and HBcAb. If HBV markers were negative, a qualitative HBV DNA PCR was done to detect OBI. The data was analyzed using SPSS 17 software, and the frequency test was used to determine prevalence. Results: In this study, 251 candidates for chemotherapy were recruited. Of this number, 114 (45%) patients were women. Mean patient age was 52.6 years. A total of 149 (59%) study subjects were employed, and the others were housekeepers or self-employed. About 67 (26.6%) patients had a history of one dose and 40 (15.9%) patients had a history of complete HBV vaccination. HBsAg was positive in 6 (2.4%) and HBcAb was positive in 33 (13.1%) patients; qualatative HBV DNA PCR was positive in 2 (0.8%) patients. Conclusion: This study revealed that OBI infection has a low prevalence, but patients referring for chemotherapy are at risk for its reactivation. On the other hand, isolated HBcAb is also a risk factor; therefore, in addition to HBsAg, it is recommended that HBcAb be evaluated before chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Occult hepatitis B virus infection (OBI) is defined as the presence of hepatitis B virus (HBV) DNA in serum and/or liver in HBsAg‐negative patients. We investigated the prevalence of OBI in large chronic haemodialysis (CHD) and kidney transplant recipients (KTxR) cohorts, including determination of HBV DNA in peripheral blood mononuclear cells (PBMCs). Methods: HBV DNA was determined in both serum and PBMCs in 417 CHD patients, 417 KTxR, 20 HBsAg‐positive non‐CHD non‐KTx patients (positive controls) and 40 HBsAg‐negative healthy subjects (negative controls). Results: Chronic haemodialysis group: two of 376 patients were HBsAg‐positive. The 374 HBsAg‐negative patients tested negative for HBV DNA in both serum and PBMCs. KTxR group: 14 of 417 patients were HBsAg‐positive. One of 403 HBsAg‐negative patients tested positive for HBV DNA in serum but not in PBMCs. Positive controls: six of 20 patients were under antiviral therapy and had negative HBV DNA in both serum and PBMCs. In 11 of 14 remaining patients, HBV DNA was detected in serum and in both serum and PBMCs in 3 patients. Negative controls: All 34 patients were anti‐HBc‐negative and HBV DNA‐negative in both serum and PBMCs. In the long term, the only case of anti‐HBc‐negative OBI lost anti‐HBs 5 years after inclusion in the study and showed HBV reactivation with HBsAg re‐seroconversion. Conclusions: We found nil prevalence of OBI in CHD patients and a very low prevalence (<1%) in KTxR suggesting that routine screening for HBV DNA is not required in CHD population in our region. However, in KTxR, pretransplant screening with HBV DNA should be considered. Testing for HBV DNA in PBMCs does not seem to be of additional value. [ABSTRACT FROM AUTHOR]

Hepatitis B virus (HBV) infection is a serious nosocomial infection that affects patients undergoing hemodialysis (HD). However, certain HBV variants are not detected by routine serological tests in Egyptian dialysis units because of mutations that change important viral antigens (Ags). Of note, these mutations can result in the appearance of different HBV variants with different clinical manifestations. Thus, the present study aimed to assess different clinical forms of HBV infections and viral genotypes among patients undergoing HD in the Ismailia governorate of Egypt. To this end, serum samples were collected from 150 patients undergoing HD and screened for HBV‐DNA using a nested PCR technique. Positive samples were then screened for HBV serological markers (hepatitis B core antibody [HBcAb], hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B e antigen and hepatitis B e antibody) using ELISA and the HBV viral load quantitated by qPCR. HBV genotypes were detected by direct sequencing of the partial surface (S) gene. The most common clinical form of HBV infection in our study cohort was overt HBV infection (10%); followed by seropositive occult hepatitis B infection (7.3%), most of whom had an isolated HBcAb. The least common form was the precore mutant (1.3%). All HBV isolates were genotype D. This study reveals the importance of HBcAb and PCR in screening for HBV, especially for detection of occult hepatitis B infection. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis B virus (HBV) infection in children is a health problem worldwide. In Mexico, a high prevalence rate of HBV infection and occult HBV infection have been reported in high-risk adults and children. However, studies regarding HBV infection transmitted from HBV-infected parents to children are limited. This study aimed to determine the risk factors associated with HBV transmission of HBV from parents to children in Mexico. Methodology: A retrospective case-control study was carried out in 24 pediatric patients with clinical HBV infection and 48 healthy controls. Bivariate and forward conditional logistic regression analysis was used to compare demographic variables, the status of HBV vaccination, and risk factors for HBV infection transmission among children and their parents. Results: No newborns were diagnosed with HBV infection, and no significant differences were found in age (p = 0.209) or gender (p = 0.612) compared to the control group. The independent risk factor associated with HBV transmission was the presence of a parent with a history of promiscuity (OR = 30.95, 95%CI = 3.382-283.326; p = 0.002), whereas having completed the HBV vaccination schedule for their age was a protective factor against HBV infection in the children (OR = 0.245, 95%CI = 0.079-0.764; p = 0.015). Conclusions: HBV infection in Mexican children is associated with close interpersonal contact with a parent engaged in high-risk sexual practices suggesting that the horizontal route could be the primary mode of infection. Child and adult vaccination campaigns should be reinforced to avoid HBV infection in Mexico. [ABSTRACT FROM AUTHOR]

Aim. Evaluate significance of covalently closed circular DNA of hepatitis В virus as a marker for detection of occult viral hepatitis В in Uzbekistan population with hepatitis of various genesis. Materials and methods. Blood plasma and liver biopsy from 39 patients with different severity levels of liver fibrosis and cirrhosis served as study material. HBV covalently closed circular DNA detection was carried out according to Pollicino T. et al. (2004). Results. Covalently closed circular DNA of hepatitis В virus was detected in 82% of samples, including in 54.5% of patients with chronic viral hepatitis C (CVHC) and in 100% of patients with hepatitis of unknown etiology. Quantitative evaluation of content of covalently closed circular DNA of hepatitis В virus in liver tissue in patients with CVHB has shown an average of 2.5 copies of HBV genome as ccc DNA per cell, in patients with CVHB + D an average of 0.7 copies/cell, in patients with co-infection by HCV and HBV - 0.5 copies/cell, in patients with CVHC an average of 0.12 copies/cell, and in patients with cryptogenic hepatitis - 0.2 copies/cell. Conclusion. Detection of HBV DNA is a complex problem for effective laboratory diagnostics of hepatitis. Detection of H BV ccc DNA as a marker of occult hepatitis В in patients with CVHC and patients with hepatitis of unclear etiology is an important factor for diagnostics, selection of adequate therapy, prognosis of disease outcome and prevention of development of severe liver diseases.

The article presents the data on the rates of blood-borne viral infections (BBVI) in potential organ donors and blood donors at the N.V.Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2014. Differences in BBVI rates and multidirectional trends in the proportion of infected individuals were seen in different age groups of blood donors and potential organ donors. We analyzed the established algorithm for laboratory testing of potential organ donors for BBVI in the Russian Federation and major risks for BBVI transmission in organ and tissue transplantation. We have shown that the current algorithm of screening for BBVI in organ donors does not detect these infections duringa "window period", nor their occult forms. We studied the causes of occult BBVI forms and their significance for clinical transplantation.

The concept of occult infection caused by hepatitis B virus (HBV) is determined as the presence of HBV DNA in blood sera or liver with the absence of detectable HBsAg. The actuality of this problem is associated with the fact, that occult hepatitis B (OHB) can be transmitted during hemotransfusions, cause reactivation of chronic hepatitis B in immune compromised individuals, facilitate development of liver cirrhosis and hepatocellular carcinoma. Several different hypotheses of OHB immunopatho-genesis have been proposed, including a low number of copies of HBV DNA, altered immune response of the macroorganism, genetic variability of the S gene, integration of viral DNA into host genome, infection of mononuclear cells of peripheral blood, presence of immune complexes that hide HBsAg, and interference by other viruses such as HCV and HIV Molecular mechanisms of HBVvirus in HBsAg-negative individuals are not fully understood, however, viral mutations seem a very significant factor. Approaches of OHB prophylaxis including use of a polyvalent vaccine, that allows vaccination against wild and mutant HBV viruses, are examined.

INTRODUCTION: Occult hepatitis B infection (OBI) is considered to be one of the major risks for patients suffering from end-stage renal disease (ESRD) on regular hemodialysis (HD) and patients with chronic hepatitis C virus (HCV) infection. This study compared the prevalence of OBI among these two high-risk groups in the Suez Canal region, Northeastern Egypt, to obtain a better national overview of the magnitude of OBI in this region. METHODS: Serum samples were collected from 165 HD patients and 210 chronic HCV-infected patients. Anti-HCV antibody, hepatitis B surface antigen (HBsAg), total hepatitis B core (anti-HBc) antibody, and hepatitis B surface antibody (anti-HBs) were detected by enzyme-linked immunosorbent assay (ELISA). HCV RNA was detected using a quantitative real-time RT-PCR assay, and HBV was detected using a nested PCR. RESULTS: All patients were negative for HBsAg. A total of 49.1% and 25.2% of the patients in the HD and HCV groups, respectively, were anti-HBc-positive. In addition, more anti-HBs-positive patients were detected in the HD group compared to the HCV group (52.1% and 11.4%, respectively). Three cases were positive for HBV DNA in the HD group, while eighteen positive cases were detected in the HCV group. Both study groups showed significant differences in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) level as well as anti-HBc, anti-HBs and HBV-DNA positivity. CONCLUSIONS: OBI was more prevalent among chronic HCV patients than HD patients in the Suez Canal region, Egypt, with rates of 8.5% and 1.8%, respectively. However, more precise assessment of this infection requires regular patient follow-up using HBV DNA detection methods.

Objective To analyze the clinical characteristics and therapeutic efficacy of 38 cases of occult hepatitis B patients. Methods The data of 38 occult hepatitis B patients were analyzed statistically. Anti- virus therapy， anti- fibrosis therapy and reducing liver enzyme therapy were given to these patients. Hepatic transient elastography, HBV DNA and liver function were used to evaluate the treatment effects. Re s ults Among the 38 cases of occult hepatitis B patients, there were 4 cases of F1 (non- fibrosis)，23 cases of F2 （minimal fibrosis）， 10 cases of F3 (middle to severe fibrosis)，F4 (early- stage cirrhosis). When evaluate the HBV DNA level，there were11cases （28.95%） between 20- 10² IU/L，19 cases （50.0%） in 103IU/L, and 8 cases （21.05%） in 104 IU/L．25 patients （65.79%） had abnormal liver function test. After 12 months of treatment，only 1 patient is F2. HBV DNA sero- conversion rate is 81.58% ．They all had normal liver function test. Conclusion Once early detection is made，there can be good effect when patients receive anti- virus therapy and anti- fibrosis therapy. [ABSTRACT FROM AUTHOR]

In the present study, we evaluated the prevalence of occult hepatitis B (OBI) in a population from the Brazilian Amazon region, identify circulating genotypes, and mutations in the S gene. One hundred eighty‐one patients with negative serology for HBsAg and anti‐HBs and positive serology for anti‐HBc participated in the study. Detection of viral DNA, genotyping by sequencing, and analysis of nucleotide sequences to detect possible mutations were performed. HBV DNA was detected in 14.36% of the patients. Genotyping revealed genotype A in 88.46% of HBV DNA‐positive subjects, with subgenotype A1 being the most prevalent (78.26%) followed by subgenotype A2 (21.74%). Genotype F was detected in 11.54% (all of them subgenotype F2). Amino acid substitutions were observed in the amplified S gene in individuals with OBI compared to HBsAg‐positive individuals (evident infection). In conclusion, the results show a high prevalence of OBI in the population studied, with a pattern of genotypes A and F that circulate in the Brazilian Amazon region. Amino acid substitutions were detected in part of the S gene in patients with OBI. Further studies on the molecular epidemiology of HBV in this region are important to identify patients considered healthy but who are potential transmitters of the disease. [ABSTRACT FROM AUTHOR]

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Background and study aims Occult hepatitis B infection (OBI) is known to be mostly prevalent in chronic hepatitis C (CHC) patients and OBI reactivation might be life-threatening in patients undergoing interferon (IFN)-free direct acting antiviral (DAA) therapy. As previous studies have revealed a relationship between OBI and non-response to IFN-based antiviral therapy, the aim of the current study was to determine if there was a higher prevalence of OBI in IFN non-responders than responders. Patients and Methods This retrospective cross-sectional study was conducted in CHC patients who had previously received IFN-based antiviral therapy. Serum samples of 100 HBsAg negative CHC patients were tested for HBV DNA, anti-HBc IgG, anti-HBs, ALT and AST. The presence of OBI was compared between 50 IFN responders and 50 IFN non-responders. Patients with a history of previous HBV infection, patients with evidence of cirrhosis and patients who had received IFN therapy within the last one year were excluded from the study. Results Anti-HBc IgG positivity was determined in 53% of the patients. HBV DNA positivity, indicating OBI was determined in 1 (1%) patient. This patient was anti-HBc IgG positive, anti-HBs negative, ALT and AST levels were normal. The HBV DNA and anti-HBc IgG positivity rates were higher in the non-responder group than in the responder group, but the difference was not statistically significant ( p  = 0.31 and p  = 0.07 respectively). Conclusion According to the results of this study, the prevalence of OBI is lower than expected amongst CHC patients in Turkey and it may not be necessary to apply routine screening to IFN non-responders for OBI infection before DAA therapy. However, there is a need for multicentre studies with larger patient series. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the serological and molecular prevalence of hepatitis B virus (HBV) infection in 514 manicurists/pedicurists and identify the risk factors related with this infection. Samples were tested for HBV serological markers, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) by enzyme-linked immunosorbent assay (ELISA). Anti-HBc-positive samples were tested to investigate occult hepatitis B by PCR. HBsAg-positive samples were genotyped and the viral loads of HBV-DNA positive samples were quantified. The overall HBV prevalence was 5.6% (29/514) and of HBsAg was 0.4% (2/514). One case of occult hepatitis B was found. The genotypes A1 and F2 were identified in two HBsAg-positive samples. Low level of education, not being born in the State of Mato Grosso do Sul and working in the central region of the city were associated with the HBV infection. No single manicurist/pedicurist was infected by HCV or HIV. These findings suggest that despite the exposure to blood contact, this occupation was not associated to an increased risk of acquiring HBV, HCV, and HIV infections. [ABSTRACT FROM AUTHOR]

Simultaneous detection of anti-HBs and HBV DNA is a rare serological combination and has been described in acute and chronic HBV infection. To scrutinize viral and clinical patterns associated with concurrent detection of anti-HBs and HBV DNA. Simultaneous detection of anti-HBs and HBV DNA was observed in 64/1444 (4.4%) patients treated for HBV infection at the University Hospital of Essen from 2006 to 2016 (8 with acute, 20 with reactivated, and 36 chronic HBV infection). Clinical data and laboratory parameters were analyzed. Regions of the small hepatitis B surface antigen (SHB) and the reverse transcriptase (RT) were sequenced using next generation sequencing (NGS). Among the 64 patients with detectable HBV DNA and anti-HBs, 17 were HBsAg negative (HBsAg[−]), and two had acute liver failure. Patients with acute HBV infection had fewer genotype specific amino acid substitutions in the SHB region than patients with reactivated HBV infection (4 [4.5] vs 9 [16.25], P = 0.043). However, we could observe a significantly higher number of mutations in the a-determinant region when comparing chronically infected patients to patients with acute infection (0 [1] vs 1 [1], P = 0.044). The ratio of nonsynonymous to synonymous mutations (Ka/Ks) was on average >1 for the SHB region and <1 for the RT region. The Ka/Ks ratio (>1) in the SHB region indicates that anti-HBs might have exerted selection pressure on the HBsAg. In three cases the diagnosis of acute HBV infection would have been at least delayed by only focusing on HBsAg testing. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Occult hepatitis B (OHB) virus infection is defined as the presence of hepatitis B virus (HBV) DNA in the liver tissue or serum of subjects seronegative for hepatitis B surface antigen. OHB leads to the potential risk of transmission in dialysis service. Routine HBV vaccine in dialysis patients is recommended. However, HBV vaccine response rates are lower than the community. The aim of this study was to determine the prevalence of OHB in hepatitis B vaccinated dialysis patients. MATERIAL and METHODS: This study was performed at the Nephrology Department, Faculty of Medicine, Cumhuriyet University, between st January - 3st December 2014. Sera from 200 dialysis patients with negative HbsAg were investigated for HBV DNA using the polymerase chain reaction (PCR). RESULTS: The mean age of the patients was 59.57±14.89 (18-91) years; 179 of them were on hemodialysis and 21 were on peritoneal dialysis. Of the patients included in the study, anti-HBs positivity was present in 135 (67.5%) and anti-HBs negativity in 65 (32.5%). The OHB prevalence was 1.5% (n=3). CONCLUSION: In our study, the OHB prevalence was 1.5%. We assume that HBV infection would be reduced further by routinely applying HBV PCR tests for all patients who start dialysis and by taking precautions against transmission. [ABSTRACT FROM AUTHOR]

Occult Hepatitis B corresponds to the presence of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) in serum and/or in liver of a patient despite HBsAg negativity. Clinically, it is usually asymptomatic. Its reactivation is rare and commonly occurs in immunosuppressed individuals. We report the case of a 21-year old patient from Senegal, with homozygous sickle cell disease, presenting with cholestatic jaundice. Laboratory tests showed reactivation of occult Hepatitis B. This study emphasizes the need to systematically investigate the presence of occult Hepatitis B in patients with sickle cell disease suffering from acute liver disease. [ABSTRACT FROM AUTHOR]

Background/purpose: Occult hepatitis B infection (OHB) is not rare in countries that are endemic for hepatitis B virus (HBV) and in patients with chronic hepatitis C virus (HCV) infection. Notably, OHB has been shown to play a role in the progression of liver diseases, including the development of hepatocellular carcinoma (HCC); however, the data is inconsistent. We aim to clarify the contribution of concurrent OHB to the progression of liver diseases in a long-term cohort of patients with HCV infection and to investigate the value of total anti-hepatitis B core (anti-HBc) antibody as a surrogate OHB biomarker.Methods: We included 250 chronic anti-HCV-positive patients who had resolved HBV infection (anti-HBc positive and hepatitis B surface antigen negative). OHB was then detected using a sensitive commercial assay for serum HBV DNA with a low limit of detection of 6 IU/mL. Clinical outcomes, including the development of liver cirrhosis, HCC, and all-cause deaths, were compared between OHB-positive and OHB-negative patients.Results: At baseline, only 183 (73.20%) patients had positive HCV ribonucleic acid, and 56 (30.60%) of these 183 patients with active HCV infection had OHB. The presence of OHB did not correlate with any adverse clinical outcome in multivariate analyses. In addition, chronic hepatitis C patients with OHB did not have a higher level of serum total anti-HBc.Conclusion: OHB infection may not contribute to the development of adverse liver outcomes in patients with chronic HCV. [ABSTRACT FROM AUTHOR]

Aim of the study: The aim of the study was to analyze the prevalence of risk factors for non-alcoholic fatty liver disease (NAFLD) in patients with non-B non-C hepatocellular carcinoma (HCC). Methods: Between June 2012 and November 2014, patients with HCC, negative for hepatitis B surface antigen and hepatitis C virus antibody, were included in this study. All patients were assessed for risk factors for NAFLD such as diabetes mellitus (DM), hypertension, dyslipidemia, metabolic syndrome, and obesity. Results: Forty-seven patients with non-B non-C HCC (males, 37; age, 60±10 years; mean±SD) were studied. Model for end-stage liver disease score was 11±4. Twenty-five patients were in Child's class A. History of significant alcohol intake was noted in 11 (23%) patients. Prevalence of risk factors for NAFLD were obesity 24 (51%), DM 22 (47%), metabolic syndrome 21 (45%), hypertension 16 (34%), and dyslipidemia 13 (28%). Forty (85%) patients had at least one risk factor for NAFLD. The mean duration of at least one NAFLD risk factor was 7.5 years, prior to diagnosis of HCC. Thirteen (28%) patients were positive for anti-HBc; however, none of the study patients had detectable HBV DNA in blood. Conclusions: Eighty-five percent of the patients with non-B non-C HCC had at least one risk factor for NAFLD. None of the study patients had occult hepatitis B infection. NAFLD is emerging as the major etiological contributing factor for non-B non-C HCC in India. [ABSTRACT FROM AUTHOR]

Hepatitis B is a "silent epidemic", fifty to a hundred (50-100) times more infectious than HIV, a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). HBV can cause acute and chronic infection and subsequently results in a high risk of death from cirrhosis and liver cancer. Despite the availability of a safe and effective vaccine, HBV continues to be a global burden including in The Gambia. This study reviewed the recent trends in the epidemiological characteristics of HBV in the Gambia. The researchers conducted an online literature search for primary studies on HBV prevalence published in the past two decades from Jan 1992 to Feb 2022 inclusive on Google Scholar, PubMed, and Scopus. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness, and methodological coherence. We found that HBV infection prevalence is above 8% in The Gambia. Moreover, HBV is the most common cause of hepatocellular carcinoma (HCC) in Gambia. Liver cirrhosis and HCC have the highest mortality contribution among hepatitis patients, with occult HBV carriers as major culprits. Also, vaccination coverage has declined from 91% to 88% according to reports from current literature. To achieve the WHO goal of eliminating HBV by 2030, policies targeting infection transmission control among risk groups, community awareness programs, research, price reduction of drugs, mass vaccinations, and diagnostics should be urgently instituted., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: Infections due to blood-borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV), as well as bacterial infections are among important problems in hemodialysis patients. In this study, we aimed to determine the seroprevalence of HBV, HCV and HIV in patients undergoing hemodialysis, to reevaluate the patients susceptible to HBV, to screen isolated anti-HBc-positive patients for occult hepatitis B after identifying them. Methods: 124 patients in hemodialysis programme and aged older than 18 years were included in this retrospective study. HBsAg, anti-HBs, anti-HBc total, anti-HCV and anti-HIV were studied. HBV DNA and HCV RNA were investigated in patients with isolated anti-HBc and anti-HCV antibody, respectively. Results: HBsAg and anti-HIV were negative in all patients. The number of anti-HBs-negative and anti-HBs-positive patients was 21 (16.9%) and 103 (%83.1), respectively. Of patients, 64 (51.6%) were negative and 60 (%48.4) were positive with respect to anti-HBc. Of anti-HBs-positive patients, 50 (40.3%) had anti-HBc antibodies indicating that they had gained immunity against HBV by having the infection. Anti-HBc was positive in 10 (8%) of anti-HBs-negative patients. All of these patients whose HBV DNA was negative were included in the vaccination program. Anti-HCV was negative in 120 (96.8%) patients, and positive in 4 (3.2%) patients in whom HCV RNA was negative. Conclusions: Hepatitis and HIV markers should be checked for patients in hemodialysis centers. HBV-sensitive patients should be vaccinated and the necessary precautions should be taken. [ABSTRACT FROM AUTHOR]

In this report we present current data on prevalence, clinical significance and methods of diagnostics of occult hepatitis B. Mechanisms of occult hepatitis B formation are reviewed, among which the most important is co-infection with other hepatotropic viruses. Diagnostic significance of anti-HBcAg antibodies is shown. An algorithm of occult hepatitis B detection developed by the authors involves two stages: detection of viral markers in serum and liver tissue. Attention is drawn to the role of morphologic methods including histochemistry, immunohistochemistry and electron microscopy in verification of HBVinfection and direct visualization of virions in cytoplasm of hepatocytes.

Abstract Background and objectives: Hepatitis B virus infection is a major health problem in worldwide. The prevalence of Occult and chronic HBV in hemodialysis patients is higher than standard in developing countries. People with occult HBV are negative for HBV surface antigen (HBsAg) but positive for HBV-DNA. We aimed to evaluate occult hepatitis B infection in patients under hemodialysis in Panje-Azar hospital in Gorgan. Material and Methods: In this study, taken place from 2009 to 2010, the participants were 100 hemodialysis patients with administration of complete HBV vaccination with negative test for HBsAg. After preparing 10 milliliter blood sample, HBV DNA testing was performed by polymerase chain reaction (PCR). Result: The mean age of the patients is 54.60 years. They are male (48%) and female (52%). They have been under hemodialysis for 48 months, averagely. There has not been any HBV-DNA in HBsAg negative patients under hemodialysis. The rate of occult hepatitis B infection in these end stage renal disease (ESRD) patients was zero. Conclusion: Results indicate that there is no any occult HBV infection in ESRD patients under hemodialysis in Gorgan, which is similar to some studies. The results could be justified by complete vaccination of the patients. Key words: Occult Hepatitis B, Hemodialysis, HBsAg, Gorgan

Occult hepatitis B virus (HBV) infection (OBI) is characterized by presence of HBVDNA in blood or liver tissue without detectable HBV surface antigen (HBsAg), with or without antibodies to hepatitis B core antigen (anti-HBc) or antibodies against HBsAg (anti-HBs). A molecular and serological characterization was done of OBI in blood donors from Yucatan, Mexico. HBV DNA was found in 24 (6.4%) of the 372 evaluated samples. Anti-HBs was present in 15/24 samples (62.5%), and no significant difference was observed between HBV DNA positivity and anti-HBs levels. HBV genotype H was detected in 66.7% of samples, followed by genotypes D (20.8%) and F (8.3%). Amino acid substitutions were identified in the core region of nine samples, and most of these changes were located in immunodominant epitopes. No precore stop codon 28 mutant (W28Stop) was identified among the analyzed HBV isolates. In conclusion, genotype H is the main circulating HBV strain among OBI blood donors from Yucatan, Mexico. Mutations in the core region may contribute to viral persistence.

INTRODUCÃO: A hepatite C é uma das principais causas de doença hepática em todo mundo. Apresenta um curso evolutivo dinâmico e influenciável por diversos co-fatores. Dentre eles, a infecção pregressa pelo vírus B (anti-HBcAg [+] e HBsAg [-]) tem se associado a pior prognóstico histológico e terapêutico. Este trabalho teve como objetivo analisar a associação entre a infecção pregressa pelo vírus B e fibrose hepática em portadores de hepatite C crônica, de maneira independente. MÉTODOS: Foram revistos retrospectivamente prontuários médicos de pacientes infectados cronicamente pelo vírus C, atendidos consecutivamente durante um ano no ambulatório de Doenças Infecciosas e Parasitárias - HC FMUSP, quanto aos dados epidemiológicos, clínicos, laboratoriais e histológicos. A análise de independência do impacto da infecção pregressa pelo vírus B foi realizada através de modelo estatístico de regressão logística multivariado, considerando a detecção do anti-HBcAg como variável de exposição, sendo o desfecho a alteração estrutural histopatológica graus 3 e 4 (septos com formação de nódulos e cirrose).0 RESULTADOS: 145 indivíduos foram avaliados pelo estudo, 47.2% com anti-HBcAg (+). O fator de risco mais comumente relatado foi transfusão de sangue e hemoderivados (35,9%). Embora necrose em saca-bocado tenha sido encontrada com maior frequência no grupo de infecção pregressa, a sorologia anti-HBcAg (+) não se associou à fibrose hepática avançada. CONCLUSÕES: A infecção pregressa pelo vírus B não parece acentuar a lesão estrutural desencadeada pela hepatite C crônica, após controle estatístico para outros co-fatores sabidamente capazes de influenciar a história natural desta infecção.INTRODUCTION: Hepatitis C is a major cause of liver disease worldwide. Its evolutionary course is dynamics and may be influenced by several cofactors. Among them, previous hepatitis B virus infection (anti-HBcAg [+] and HBsAg [-]) has been associated with worse histological and therapeutic prognosis. This study had the objective of independently assessing the relationship between previous hepatitis B infection and liver fibrosis in patients with chronic hepatitis C. METHODS: The medical records of patients chronically infected with the hepatitis C virus who had been seen consecutively during a one-year period at the infectious and parasitic diseases outpatient clinic of HC FMUSP were retrospectively reviewed in relation to epidemiological, clinical and histological data. Analysis on the independence of the previous hepatitis B infection was performed using the statistical model of multivariate logistic regression. Detection of anti-HBcAg was taken to be the independent variable. The outcome was taken to be grade 3 and 4 histopathological abnormality (septa with nodule formation and cirrhosis). RESULTS: 145 subjects were evaluated in this study. 47.2% of them were anti-HBcAg (+). The main risk factor for infection was blood and blood derivative transfusion (35.9%). Findings of anti-HBcAg (+) were not related to advanced liver fibrosis, although piecemeal necrosis has been found frequently in patients with this serological marker. CONCLUSIONS: Previous hepatitis B infection does not seem to increase the structural liver damage triggered by chronic hepatitis C virus infection, after statistical control for other co-factors capable to impact the natural history of this infection.

Objetivo: Establecer la frecuencia de la infección por Hepatitis B en los pacientes VIH positivos atendidos en la IPS VitalSalud de Barranquilla, Colombia. Métodos: Se realizó un perfil serológico para Hepatitis B en los pacientes VIH positivos, consistente en: HBs Ag, Anticore IgG. Estos exámenes se practicaron entre el mes de junio del 2007 hasta julio del 2009. Resultados: En 24 meses se realizaron exámenes para la detección de Hepatitis B en 103 pacientes VIH positivos. Hubo una prevalencia del 3,1% (tres pacientes) con Hepatitis B crónica. Cuatro pacientes fallecieron durante el período del estudio, ninguno positivo para infección por Hepatitis B. Se detectaron 6 pacientes con Ig G core para VHB positivo aislado, es decir con sospecha de Hepatitis B oculta, la cual se confirmó solo en un paciente con carga viral para ADN de VHB positiva (158 copias/ml). Este paciente no se hallaba usando lamivudina en el momento del examen. Conclusión: La prevalencia de Hepatitis B en nuestros pacientes corresponde a la reportada en todo el territorio nacional. La búsqueda de infección oculta por Virus de Hepatitis B en los pacientes VIH positivos asistentes a nuestra institución arrojó como resultado un solo paciente con esta patología y con una baja carga viral. La estrategia para el diagnóstico la infección oculta por VHB en los pacientes usando lamivudina debe ser más estudiada.Objective: The objective is to establish the frequency of Hepatitis B (VHB) co-infection in HIV outpatients at VitalSalud Health Center in Barranquilla, Colombia. Methods: Two serological tests to diagnose Hepatitis B in our HIV patients were performed: Hepatitis B surface antigen and Anticore type Ig G (anti HBC Ig G). These tests were run between July, 2007 and July, 2009. Results: The tests were applied to 103 HIV patients. There was a prevalence of 3.1% (3 patients) for chronic Hepatitis B. Four patients passed away during the study term, none of them was Hepatitis B positive. Six patients with isolated anti HBc Ig G were detected, and only one of them had a positive viral load for VHB DNA (158 copies/ml). This patient was not taking lamivudine at the time of the test. Conclusions: The prevalence of VHB in our patients is similar to the prevalence reported in our country as a whole. The search for occult hepatitis B was positive, with a low viral load, in one out of 103 of our patients. The strategies for diagnosis of occult hepatitis B in HIV patients under lamivudine treatment require further research.

Recentemente é descrito estado de persistência do vírus da hepatite B denominado hepatite crônica B oculta. Sua prevalência e fisiopatologia são desconhecidas. O objetivo deste estudo foi avaliar a ocorrência dessa entidade clínica em pacientes da Amazônia brasileira. De 51 pacientes anti-HBc total reativos testados pela reação em cadeia da polimerase, 17% foram positivos. Não observamos associação com fatores de risco clássicos de infecção pelo vírus da hepatite B, testes bioquímicos, hematológicos e histopatologia. No entanto, os pacientes ictéricos e reativos para o anti-HIV apresentaram associação com a presença do ADN-vírus da hepatite B. Os resultados demonstram a ocorrência da hepatite crônica B oculta, entre nossos doentes, porém, com taxas de prevalência abaixo do esperado para a região. Acreditamos que, apesar do tamanho da amostra avaliada ser pequeno, sua ocorrência poderia ter sido maior se empregássemos primers para a região S, C e X do genoma do vírus da hepatite B, aumentando a sensibilidade do teste.A persistent form of the hepatitis B virus called occult chronic hepatitis B has recently been described. Its prevalence and physiopathology are unknown. The aim of this study was to evaluate the occurrence of this clinical entity among patients in the Brazilian Amazon region. Out of 51 anti-HBc total-positive patients who were tested using the polymerase chain reaction, 17% were positive. We did not find any associations with classical risk factors for hepatitis B virus infection or with biochemical tests, hematological tests or histological patterns. However, the jaundiced and HIV-positive patients showed a statistical association with the presence of hepatitis B virus-DNA. The results demonstrated that occult hepatitis B occurred among our patients, but at prevalence rates lower than expected for this region. We believe that despite the small sample size, the occurrence might have been found to be greater if we had used primers for the S, C and X regions of the hepatitis B virus genome, thereby increasing the sensitivity of the test.

Occult hepatitis B virus (HBV) infection has been reported among patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC). Our aim was to evaluate the presence of occult HBV infection in patients with HCV-related liver cirrhosis (LC) with or without HCC in São Paulo, Brazil. Serum and liver tissue samples from 50 hepatitis B surface antigen-negative patients with HCV-related LC who underwent liver transplantation at the University of São Paulo School of Medicine Hospital from 1993 to 2004 were divided into groups with LC only (N = 33) and with LC plus HCC (N = 17). HBV DNA was assayed for serum and paraffin-embedded liver tissue (tumoral and non-tumoral) using real time PCR and only 1 case with HCC had HBV DNA-positive serum. All liver samples were negative. HCV genotype 3 was detected in 17/39 (43.7%) cases. In conclusion, using a sensitive real time PCR directed to detect HBV variants circulating in Brazil, occult hepatitis B infection was not found among HCV-positive cirrhotic patients and was rarely found among HCV-positive HCC patients. These results are probably related to the low prevalence of HBV infection in our population. Furthermore, we have also shown that HCV genotype 3 is frequently found in Brazilian cirrhotic patients, particularly when they also have HCC. More studies involving a large number of cases should be carried out to confirm these data and to further characterize Brazilian HCV genotype isolates to elucidate genetic features that might be related to its carcinogenic potential.

• Hepatitis B surface antigen seroclearance (SC) is regarded as functional cure of chronic hepatitis B infection. • Highly sensitive assays used in this study detected hepatitis B virus (HBV) surface and core-related antigens in >70% patients with SC. • This study reiterates the potential of using sensitive HBV antigen detection assays to detect low levels of viral activity in patients with SC or patients with occult hepatitis B infection. • Correlation between low levels of HBV antigens and disease progression deserved further investigations. This study aimed to evaluate the usefulness of two novel assays, namely the iTACT-hepatitis B surface antigen (iTACT-HBsAg) and iTACT-hepatitis B core-related antigen (iTACT-HBcrAg) assays, in chronic hepatitis B (CHB) patients with HBsAg seroclearance (SC) documented by standard assays. HBsAg and HBcrAg were measured by the two iTACT-assays in 556 serial sera collected from 96 CHB patients at 7 different time points spanning from 5 years before to 10 years after SC and 120 HBsAg-negative, anti-HBc-positive individuals. As controls, 60 seronegative individuals, who were negative for HBsAg, anti-HBc and anti-HBs, were tested. Using the iTACT-assays, HBsAg was detectable in 154/418 (36.8%) samples collected after SC. HBcrAg was detectable in 78.3% and 65.9% of samples collected before and after SC, respectively. The detectability rates of both HBsAg and HBcrAg progressively decreased over time after SC. At 10 years after SC, 20.4% and 64.5% of the patients still had detectable HBsAg and HBcrAg, respectively. 66 (71%) patients had detectable HBsAg and/or HBcrAg. Among the 120 HBsAg-negative, anti-HBc-positive individuals, 11 (9.2%) and 4 (3.3%) had detectable HBsAg and HBcrAg respectively. Both HBsAg and HBcrAg were undetectable in the controls. The iTACT assays detected a low level of HBsAg and/or HBcrAg in >70% of patients even at 10 years after SC, suggesting that CHB patients with SC still harbour a low level of HBV protein expression. The clinical significance of detectable viral proteins after SC with regard to disease progression and HBV reactivation deserves further investigations. [ABSTRACT FROM AUTHOR]

Introduction: Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. Occult HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the hepatitis B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing occult HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing occult HBV. Here, we present the first report of occult HBV following adult vaccination. Case Presentation: A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT = 1873 IU/mL; AST = 4518 IU/mL), and she was found to have HCV and occult HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient's HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed. Conclusions: HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing occult HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing occult HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti- HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg. [ABSTRACT FROM AUTHOR]

Hepatitis B virus (HBV) infection in patients who lack detectable hepatitis B surface antigen (HBsAg) is called occult hepatitis B infection. Such infections have been frequently identified in patients with chronic hepatitis Cliver disease, but their prevalence is not known.Methods: 207 patients with chronic hepatitis C who were HCV -RNA and antiHCV positive were studied for HBV-DNA by PCR, and for HBsAg and anti-HBc by ELISA. DNA was extracted by high pure nucleic acid kit (Roche-Germany). HBVDNA amplification was done with a set of primer directed to the pre-S region. HBsAg and anti-HBc were evaluated by a commercially available ELISA kit (Dade Behring). Results: 23 of 207 patients with chronic hepatitis Cliver disease ( 11.1%) were positive for HBV-DNA (co-infection). Among this group 17 patients (8.2%) were HBsAg negative (occult infection). 8 of 17 patients with occult infection ( 4 7%) were anti-HBc positive and 9 were anti-HBc negative (53%). No significant difference was found in epidemiological and biochemical parameters in patients with HCV alone in comparison with HCV co-infected with occult hepatitis B (p= 0.453 for ALT and p= 0.498 for AST).Conclusion: Occult hepatitis B virus infections occur frequently in patients with chronic hepatitis Cliver disease and may have clinical significance.