Occult Hepatitis B: Clinical Viewpoint and Management

Occult HBV infection (OBI) is defined as HBV DNA detection in serum or in the liver by sensitive diagnostic tests in HBsAg-negative patients with or without serologic markers of previous viral exposure. OBI seems to be higher among subjects at high risk for HBV infection and with liver disease. OBI can be both a source of virus contamination in blood and organ donations and the reservoir for full blown hepatitis after reactivation. HBV reactivation depends on viral and host factors but these associations have not been analyzed thoroughly. In OBI, it would be best to prevent HBV reactivation which inhibits the development of hepatitis and subsequent mortality. In diverse cases with insufficient data to recommend routine prophylaxis, early identification of virologic reactivation is essential to start antiviral therapy. For retrieving articles regarding OBI, various databases, including OVID, PubMed, Scopus, and ScienceDirect, were used.

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Development of occult hepatitis B viral infection in pregnancy: implications for antenatal screening in women from endemic areas

Obstetric Medicine ◽

10.1258/om.2010.090057 ◽

2010 ◽

Vol 3 (3) ◽

pp. 115-118

Author(s):

Philip Chang ◽

Jeffrey Tu ◽

Antony Chesterman ◽

Robert Kim ◽

Peter Robertson ◽

...

Keyword(s):

Hepatitis B ◽

Vertical Transmission ◽

Peripheral Blood ◽

Hbv Dna ◽

Hbv Infection ◽

Antenatal Screening ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv ◽

Occult Hepatitis B

Occult hepatitis B virus (HBV) infection, manifest clinically by the presence of HBV deoxyribonucleic acid (HBV DNA) in peripheral blood in individuals who test negative for the HBV surface antigen (HBsAg), may occur in various clinical contexts, including under the influence of pharmacological immunosuppression in patients from areas endemic for HBV and, hence, at risk of previous exposure. Pregnancy is a condition associated with immune suppression, but whether virus-specific immunity may be suppressed to an extent sufficient to allow occult HBV infection to develop is currently unknown. This is potentially relevant not only to the mother's health but also because vertical transmission has been reported in the occult HBV infection setting. We report a 30-year-old woman from a country endemic for HBV who, prior to pregnancy, was persistently HBsAg-negative with undetectable HBV DNA in peripheral blood, in whom HBV DNA became increasingly detectable during pregnancy, peaking in the third trimester, before returning to undetectable levels postpartum. HBsAg remained negative and liver function tests were normal throughout. Immunoglobulin M hepatitis B core antibody, a marker of the possibility of acquisition of a new HBV infection, was also negative. The baby received immunization against HBV infection from birth and has remained HBV negative at six months. This report documents for the first time that occult HBV infection may develop during pregnancy. Further data are required regarding the prevalence of this phenomenon, predisposing factors, impact on maternal health and risk of vertical transmission so that implications for current antenatal screening strategies that do not include measurement of HBV DNA in peripheral blood can be properly determined.

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PREVALENCE OF OCCULT HEPATITIS B INFECTION IN IRANIAN CANCER PATIENTS BEFORE CHEMOTHERAPY TREATMENT

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032016000300010 ◽

2016 ◽

Vol 53 (3) ◽

pp. 175-179 ◽

Cited By ~ 3

Author(s):

Mahmud BAGHBANIAN ◽

Mehdi HALVANI ◽

Hassan Salman ROGHANI ◽

Mohammad Hassan LOTFI ◽

Mohammad Frahat YAZDI ◽

...

Keyword(s):

Hepatitis B ◽

Cancer Patients ◽

Hepatitis B Surface Antigen ◽

Hbv Dna ◽

Hbv Infection ◽

Hepatitis B Infection ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv ◽

Occult Hepatitis B

ABSTRACT Background Occult hepatitis B infection is characterized by negative hepatitis B surface antigen (HBsAg) and also detectable hepatitis B virus (HBV) -DNA, with or without hepatitis B core antibody (anti-HBc). HBV reactivation in individuals under immunosuppressive therapy is critical, occurring in occult HBV. Objective In this study, we aimed to determine the prevalence of occult HBV infection among hepatitis B surface antigen negative in cancer patients before receiving chemotherapy. Methods Sera from 204 cancer patients who were negative for HBsAg, were tested for anti-HBc antibodies. The samples that were negative for HBsAg but positive for anti-HBc also examined for HBV-DNA by polymerase chain reaction (PCR). Results Of the 204 HBsAg negative blood samples, 11 (5.4%) samples were positive for anti-HBc antibodies. HBV-DNA was detected in 9/11 (81%) of anti-HBc positive samples. Occult HBV infection in hematological cancers was more than solid cancers, 4.8% and 4.3% respectively. There was no significant difference in HBc antibody positivity based on vaccination, previous blood transfusions, history of familial hepatitis or biochemical parameters (ALT, AST, total and direct bilirubin levels) (P>0.05). Conclusion Screening of occult HBV infection by HBsAg, HBV DNA and anti HB core antibody should be suggested as a routine investigation in cancer patients before receiving chemotherapy.

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Occult hepatitis B in Egyptian thalassemic children

The Journal of Infection in Developing Countries ◽

10.3855/jidc.1706 ◽

2011 ◽

Vol 6 (04) ◽

pp. 340-346 ◽

Cited By ~ 9

Author(s):

Olfat Shaker ◽

Amal Ahmed ◽

Inas Abdel Satar ◽

Hamza El Ahl ◽

Wafaa Shousha ◽

...

Keyword(s):

Hepatitis B ◽

Hbv Dna ◽

Hbv Infection ◽

University Hospital ◽

Health Concern ◽

Hcv Rna ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv ◽

Occult Hepatitis B

Introduction: Thalassemia is hereditary anemia which requires lifelong transfusion as treatment, and hepatitis viral infection is one of the risks of repeated transfusions. Hepatitis B outbreaks in health-care settings are still a serious public health concern worldwide. Blood samples negative for HBsAg but positive for HBV-DNA, with or without the presence of HBV antibodies, are classified as "occult" HBV infection (OBI). This study investigated the prevalence of occult HBV infection in Egyptian thalassemic children. Methodology: Eighty patients admitted to the Faculty of Medicine, Cairo University Hospital, were involved in this prospective study. Strict inclusion criteria were set to nullify the effect of confounding variables and further minimize selection bias. The following laboratory investigations were performed: complete blood count (CBC); serum AST and ALT; albumin; bilirubin; HBsAg; HBeAg; HBcAb; HCV-RNA; and HBV-DNA. Results: All our patients had no clinical manifestation suggestive of hepatitis. Molecular biology studies revealed positivity for HCV and HBV at 25% and 32.5% respectively. Conclusion: The estimated risk of acquiring hepatitis B and C infection in children receiving multiple blood transfusions is surprisingly high. Moreover, occult hepatitis B infection is a considerably risk.

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Occult Hepatitis B Virus Infection: A Review Update

Bangladesh Journal of Infectious Diseases ◽

10.3329/bjid.v5i1.37714 ◽

2018 ◽

Vol 5 (1) ◽

pp. 32-38

Author(s):

Arifa Akram

Keyword(s):

Dna Amplification ◽

Epidemiological Data ◽

Diagnostic Techniques ◽

Hbv Dna ◽

Detection Methods ◽

Current Evidence ◽

Hbv Reactivation ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv

Occult HBV infection (OBI) is defined as HBV DNA detection in serum or in the liver by sensitive diagnostic tests in HbsAg negative individuals with or without serologic markers of previous viral exposure. Since OBI was first described in the late 1970s, there has been increasing concern in this topic. OBI can be both a source of virus contamination in blood and organ donations and the reservoir for full blown hepatitis after reactivation. HBV reactivation depends on viral and host factors but these associations have not been analyzed thoroughly. Although the exact mechanism of OBI yet not proved, intrahepatic persistence of viral covalently closed circular DNA under the host’s strong immune suppression of HBV replication and gene expression seems to be a cause. Current evidence suggests that OBI can favour the progression of fibrosis, cirrhosis, hepatocellular carcinoma and post transfusion hepatitis (PTH). Epidemiological data regarding the global prevalence of OBI vary due to the use of detection methods of different sensitivity and specificity. Appropriate diagnostic techniques must be adopted. Sensitive HBV DNA amplification assay is the gold standard assay for detection of OBI.Bangladesh Journal of Infectious Diseases 2018;5(1):32-38

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Occult hepatitis B infection among individuals belonging to the aboriginal Nicobarese tribe of India

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4350 ◽

2014 ◽

Vol 8 (12) ◽

pp. 1630-1635 ◽

Cited By ~ 1

Author(s):

Haimanti Bhattacharya ◽

Debdutta Bhattacharya ◽

Subarna Roy ◽

Attayur Purushothaman Sugunan

Keyword(s):

Hepatitis B ◽

Hbv Dna ◽

Hepatitis B Infection ◽

Tribal Community ◽

Serum Samples ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv ◽

The People ◽

Occult Hepatitis B

Introduction: The long-lasting persistence of hepatitis B virus (HBV) genomes in the liver (with or without detectable HBV DNA) of individuals with negative for HBV surface antigen (HBsAg) is termed occult HBV infection (OBI). The present study is a part of the follow up on efficacy of vaccination, 10 years post inception, and was designed to understand the prevalence of Occult Hepatitis B infection (OBI) among the aboriginal Nicobarese tribal community. Methodology: A total of 612 serum samples were collected and tested for various markers including HBsAg, Anti-HBs, Anti-HBc and HBV DNA. Part of S gene of the extracted HBV DNA was amplified by nested PCR. The amplified products were then subjected to sequencing. Genotyping was performed on the basis of phylogenetic relationship along with representative reference sequences from different sub genotypes. Results: The study revealed OBI in 11.1% of the people belonging to the Nicobarese tribe. Phylogenetic analysis showed only one genotype, HBV/D circulating among the Nicobarese population with ayw3 was the major serotype detected. Single or multiple amino acids substitutions were found in 5 of 34 samples (14.7%) which includes I110T, P120T, P/T127I, A128P, M133L and G159V. Conclusions: The detection of OBI among these aboriginal tribes is of great concern and stresses the need for the continuous surveillance as it may contribute to the progression of liver disease to a more advanced stage.

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COT-06 HBV REACTIVATION DURING AND AFTER THE TREATMENT OF MALIGNANT GLIOMA WITH TEMOZOLOMIDE

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.189 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii41-ii42

Author(s):

Masayuki Kanamori ◽

Ryuta Saito ◽

Hiroshi Uenohara ◽

Teiji Tominaga

Keyword(s):

Malignant Glioma ◽

Real Time ◽

Real Time Pcr ◽

Hbv Dna ◽

Hbv Infection ◽

Hbv Reactivation ◽

Occult Hbv Infection ◽

Occult Hbv ◽

Pharmacological Prevention ◽

B Virus

Abstract BACKGROUND It has been reported that temozolomide treatment for malignant glioma can lead to the reactivation of Hepatitis B virus (HBV) and fulminant hepatitis. However, the frequency of HBV reactivation and the preventative effect of entecavir remains unclear. In this study, we retrospectively reviewed clinical features of the cases treated by temozolomide for malignant glioma, focusing on the reactivation of HBV and the effect of entecavir. METHODS We screened 129 cases with newly diagnosed and recurrent malignant glioma for HBs antigen, HBs antibody and HBc antibody before the administration of temozolomide. HBV-DNA were quantified by real-time PCR in the HBV carrier and the cases with occult HBV infection. HBV- DNA were monitored every 1–3 months by real-time PCR during temozolomide treatment and 12 months after completion of temozolomide. Entecavir were started before temozolomide treatment to the HB carrier, and if HBV-DNA became detectable at follow-up to the cases with occult HBV infection. Results 2 (1.5%) and 20 (15%) of 129 cases were HB carrier and had occult HBV infection, respectively. HBV- DNA in both of HB carrier turned negative after administration of entecavir, but transiently turned positive again during temozolomide treatment. In the cases with occult HBV infection, 4 (20%) patients had HBV reactivation. HBV- DNA turned negative after starting entecavir without liver dysfunction. CONCLUSION HBV carrier and the cases with occult HBV infection were not rare in Japan, and HBV reactivation developed frequently during temozolomide treatment. Because pharmacological prevention of HBV reactivation with entecavir was effective, the screening and monitoring is indispensable in the treatment of malignant glioma with temozolomide.

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High Rates of Occult Hepatitis B Virus Infection in HIV-Positive Individuals Initiating Antiretroviral Therapy in Botswana

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx195 ◽

2017 ◽

Vol 4 (4) ◽

Cited By ~ 12

Author(s):

Kathleen Ryan ◽

Motswedi Anderson ◽

Ivayla Gyurova ◽

Lilliam Ambroggio ◽

Sikhulile Moyo ◽

...

Keyword(s):

Hepatitis B Virus ◽

Antiretroviral Therapy ◽

Hepatitis B ◽

Hbv Dna ◽

Hbv Infection ◽

Hiv Positive ◽

Occult Hepatitis ◽

Occult Hbv ◽

B Virus ◽

Occult Hepatitis B

Abstract Background Hepatitis B surface antigen (HBsAg)–negative but hepatitis B virus (HBV) DNA-positive infection—known as occult hepatitis B infection (OBI)—occurs in 1% to >15% of HIV-positive individuals in the United States and South Africa, respectively. However, there are no data on OBI from Botswana, a country known to be hyperendemic for chronic HBV infection and to have a significant HIV burden. Methods Two hundred seventy-two adults enrolled in an HIV treatment study of tenofovir/emtricitabine as the nucleoside backbone who were previously determined to be HBsAg negative were tested for HBV DNA at baseline and 1 year after initiation of highly active antiretroviral therapy (HAART). Results HBV DNA was detected in 72 of 272 (26.5%). Six individuals (8.3%) had HBV DNA levels greater than 200 IU/mL, and the highest viral load was 3280 IU/mL. Of 65 participants with OBI evaluated at 12 months after initiating HAART, only 1 (1.5%) had detectable HBV DNA. Conclusions Occult HBV infection is quite common in HIV-infected patients in Botswana, although its impact on the course of HIV disease progression is unknown. The suppression of occult HBV DNA levels by tenofovir/emtricitabine suggests an effective therapeutic option, although the long-term suppressive abilities remain unstudied.

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Prevalence of overt and occult hepatitis B virus infections among 135 haemodialysis patients attending a haemodialysis centre at Al-Nasiriyah city, Iraq

Iranian Journal of Microbiology ◽

10.18502/ijm.v12i5.4610 ◽

2020 ◽

Author(s):

Muslim Dhahr Musa ◽

Hekmat Kadhum Ateya

Keyword(s):

Viral Load ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Real Time ◽

Hbv Infection ◽

Occult Hbv Infection ◽

Occult Hepatitis ◽

Occult Hbv ◽

B Virus ◽

Occult Hepatitis B

Background and Objectives: The prevalence of Hepatitis B virus (HBV) infection among haemodialysis (HD) patients has been well documented. In addition to overt infection, occult Hepatitis B infection exists in which a patient who is diagnosed seronegative for Hepatitis B surface antigen (HBsAg) shows positive HBV-DNA on using more accurate molecular methods. This study aims to determine the prevalence of overt and occult HBV infection among the HD patients who had attended Al-Nasiriyah dialysis centre during a two-month period. Materials and Methods: Serological qualitative detection of HBsAg by rapid test (strips), enzyme immunoassay (EIA, HBsAg) and molecular (real-time polymerase chain reaction (real-time PCR)) was conducted for quantitative detection of HBV in HD patients’ serum. Results: The prevalence of overt HBV infection among HD patients was 3.7%. The viral load of HBV positive patients was ranging from 5.85 × 101 to 2.16 × 106 copies/ml of serum with median (7.4 × 105 copies/ml). Occult Hepatitis B was not detected in any of the seronegative HD patients (0%). Overt infection was found more in males (80%) than females (20%) (P<0.05). Similarly, infection was found to be higher among patients who had blood transfusions (80%) than those who had not (20%) with statistical significant p<0.05. Although not statistically significant, the mean duration of HD was higher among HBV positive HD patients (17.6) than HBV negative HD patients (14.3). A dual infection of HBV and HCV was not detected in this study. Conclusion: Nosocomial transmissions at HD centres and blood transfusion are important risk factors. Besides serological screening, real-time PCR offers a safeguard against the spread of overt and occult HBV infection and determines the viral load of the positive patients.

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