An Interesting Case of Isolated False-Reactive Hepatitis B Surface Antigen

The standard serologic markers used to diagnose hepatitis B infection include hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), total hepatitis B core antibody (anti-HBc), and IgM antibody to hepatitis B core antigen (IgM anti-HBc). Different markers or combinations of markers are used to identify different phases of HBV infection and determine whether a patient has acute or chronic infection or immunity due to prior infection or vaccination or is seronegative and susceptible to future infection. Isolated HBsAg seropositivity is a peculiar serological pattern that requires investigation. Herein, we present a case of an asymptomatic female without a history of liver disease or evident risk factors for hepatitis, who underwent screening for infectious disease prior to resection of basal cell carcinoma involving her eyelid. The patient’s laboratory testing showed positivity for HBsAg and the HIV 1/2 screen. To investigate, we performed serial dilutions, utilized heterophilicantibody blocking tubes, and repeated analysis using a different commercial assay (Abbott Architect i2000), all in support of a false-positive result attributed to a heterophilic antibody. Hence, we demonstrate that heterophilic antibody interference can result in isolated HBsAg positivity and recommend considering this form of interference in the differential where there is low clinical suspicion for viral infection.

HBV, HCV and HIV Seroprevalence in Syrian Refugee Patient Population Undergoing Preoperative Anaesthetic Assessment: A 10-Year Survey in a Tertiary Teaching Hospital

Objective: Migration can lead to a change in the demographic dynamics of host populations in terms of communicable diseases in destination countries. This is a potential public health challenge for health authorities. HBV and HCV infections can lead to the development of chronic liver diseases, cirrhosis and hepatocellular carcinoma, and HIV infection can lead to the development of serious opportunistic diseases. The aim of this study is to evaluate the seroprevalence of HBV, HCV and HIV in Syrian refugees and Turkish patients who were evaluated preoperatively in our hospital. Materials and methods: HBsAg, Anti-HBs, Anti-HBc, Anti-HCV and Anti-HIV results of Syrian refugee and Turkish patients who applied to surgical clinics between 2011-2021 were retrospectively reviewed. Results: The study is comprised of 54446 patients: Turkish patient group (n=20569) and Syrian refugee patient group (n=33877). The Syrian refugee patients had a significantly higher HBsAg seropositivity rate and a significantly lower anti-HBs seropositivity rate than the Turkish patients (p=0.002 and p<0.001, respectively). The anti-HCV and anti-HIV seropositivity rates were similar. The annual preoperative prevalance of HBsAg seropositivity in the Syrian refugee patients tended to significantly decrease gradually from year 2011 to year 2021 (p<0.001 for ≤30 and p=0.001 for >30 years old). Conclusion: As a result, although HBV seroprevalence gradually decreases and HCV and HIV seroprevalence is low; screening, information and treatment programs should be given due importance because of the serious disease potential and preventable conditions with precautions. In addition, preoperative screening of refugee patients coming for major surgery may be important for the safety of healthcare professionals.

Changing epidemiology and viral interplay of hepatitis B, C and D among injecting drug user-dominant prisoners in Taiwan

The spreading of viral hepatitis among injecting drug users (IDU) is an emerging public health concern. This study explored the prevalence and the risks of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) among IDU-dominant prisoners in Taiwan. HBV surface antigen (HBsAg), antibodies to HCV (anti-HCV) and HDV (anti-HDV), viral load and HCV genotypes were measured in 1137(67.0%) of 1697 prisoners. 89.2% of participants were IDUs and none had HIV infection. The prevalence of HBsAg, anti-HCV, dual HBsAg/anti-HCV, HBsAg/anti-HDV, and triple HBsAg/anti-HCV/anti-HDV was 13.6%, 34.8%, 4.9%, 3.4%, and 2.8%, respectively. HBV viremia rate was significantly lower in HBV/HCV-coinfected than HBV mono-infected subjects (66.1% versus 89.9%, adjusted odds ratio/95% confidence intervals [aOR/CI] = 0.27/0.10–0.73). 47.5% anti-HCV-seropositive subjects (n = 396) were non-viremic, including 23.2% subjects were antivirals-induced. The predominant HCV genotypes were genotype 6(40.9%), 1a(24.0%) and 3(11.1%). HBsAg seropositivity was negatively correlated with HCV viremia among the treatment naïve HCV subjects (44.7% versus 72.4%, aOR/CI = 0.27/0.13–0.58). Anti-HCV seropositivity significantly increased the risk of anti-HDV-seropositivity among HBsAg carriers (57.1% versus 7.1%, aOR/CI = 15.73/6.04–40.96). In conclusion, IUDs remain as reservoirs for multiple hepatitis viruses infection among HIV-uninfected prisoners in Taiwan. HCV infection increased the risk of HDV infection but suppressed HBV replication in HBsAg carriers. An effective strategy is mandatory to control the epidemic in this high-risk group.

Sero-prevalence of Hepatitis B virus infection and associated factors among pregnant women attending antenatal care service in health institutions in Gedeo Zone, Southern Ethiopia

Background: Hepatitis B virus infection is a major public health problem worldwide and is a major cause of morbidity and mortality. This study aimed to assess the prevalence of hepatitis B virus infection and associated factors among pregnant mothers in the Gedeo Zone, southern Ethiopia.Methods: An institution-based cross-sectional study was conducted in governmental and private health facilities in the Gedeo zone from January to April 2019. The study participants were selected using systematic random sampling techniques. The Eugene strip test was used to determine hepatitis B virus infection among pregnant mothers. The status of HIV was collected from the records. Other variables were collected from the mothers using interviewer-administered questionnaires. Binary logistic regression was used for the analysis. Adjusted odds ratios and their 95% confidence intervals (CIs) were calculated to determine the association between HBsAg seropositivity and various factors. A p-value of less than 0.05 was considered significant.Results: The prevalence of hepatitis B virus infection among pregnant mothers was 9.2% in the Gedeo Zone. Previous history of blood transfusion [AOR=5.2, 95% CI: 2.1, 12.5], previous history of hospital admission [AOR=3, 95% CI: 1.4, 6.6], history of having an abortion [AOR=4.1, 95% CI: 1.5, 11.7], age of the pregnant women [AOR=5.1, 95% CI: 1.5, 18.0], and HIV status of the mother [AOR=8.1, 95% CI: 1.9, 36.0] had a statistically significant association with HBsAg seropositivity.Conclusions: Hepatitis B virus infection was found to have higher endemicity (9.2%) in the Gedeo Zone which is higher than the national pooled prevalence which was 4.75%. Early initiation of antenatal care services which incorporate the prevention and control of HBV must be implemented by the health facilities in the Gedeo Zone.

Association of hepatitis B surface antigen seropositivity and hepatitis B surface antibody seropositivity with diabetes: a cross-sectional study based on two Chinese populations in Guangdong, China

ObjectivesTo examine whether hepatitis B surface antigen (HBsAg) seropositivity and hepatitis B surface antibody (HBsAb) seropositivity were associated with the presence of diabetes in two population-based studies in southern China, the Guangzhou Biobank Cohort Study (GBCS) and the Major Infectious Disease Prevention and Control (MIDPC) study.DesignA cross-sectional study.SettingThe GBCS was conducted among a community social and welfare organisation with branches in all 10 districts of Guangzhou. The MIDPC was conducted among the community residents in two districts of Guangzhou and three districts of Zhongshan.Participants4947 participants from the GBCS and 4357 participants from the MIDPC were included in this study.Primary and secondary outcome measuresType 2 diabetes was the main study outcome, which was diagnosed by fasting blood glucose ≥7.0 mmol/L, and/or self-reported history of diabetes.ResultsAfter adjusting for age, sex, education, occupation, smoking status, alcohol use, physical activity and body mass index, we found no association of HBsAg seropositivity in GBCS or MIDPC (OR=1.12, 95% CI 0.74 to 1.69, and OR=0.83, 95% CI 0.59 to 1.17, respectively), and HBsAb seropositivity (OR=0.85, 95% CI 0.65 to 1.12, OR=1.00, 95% CI 0.86 to 1.16, respectively) with the presence of diabetes. Null associations were found for analysis pooling GBCS and MIDPC data after similar adjustment. The adjusted OR for the associations of HBsAg seropositivity and HBsAb seropositivity with the presence of diabetes in the pooled sample was 0.91 (95% CI 0.70 to 1.19) and 0.98 (95% CI 0.86 to 1.12), respectively.ConclusionsTaking advantage of data from two large cross-sectional studies, we found no association of serological status of HBsAg and HBsAb with the presence of diabetes or glucose measures.

Lamivudine vs placebo or no treatment in preventing the transmission of hepatitis B virus during pregnancy: a systematic review and meta-analysis

Background Hepatitis B virus (HBV) infection is a severe health problem, especially in developing countries. Almost 45% of the population lives in highly endemic areas, where the most common form of transmission is mother to child transmission (MTCT). Administration of antiviral therapy has been established. Nevertheless, its efficacy still remains controversial. Methods We conducted the current study to fully evaluate the effectiveness of lamivudine in preventing the MTCT of HBV based on randomized controlled trials (RCTs). Four English electronic databases and four Chinese electronic databases were searched from the inception of each database to 26 September 2017. Studies were included if they (1) were human RCT studies, (2) indicated exposure to lamivudine, (3) explicitly indicated control to placebo or no treatment, (4) indicated the participants were pregnant women infected with HBVand (5) compared the outcome of interest as the MTCT. Extracted data were tabulated and analyzed using Review Manager. Results Eleven RCTs were included and analyzed. Compared with controls (placebo or no treatment), lamivudine significantly reduced the probability of MTCT, as indicated by newborn HBsAg seropositivity (RR=0.44, 95% CI 0.26 to 0.74, I2=41%), HBeAg seropositivity (RR=0.66, 95% CI 0.36 to 1.19, I2=0%) and HBV DNA seropositivity (RR=0.29, 95% CI 0.18 to 0.4`6, I2=0%) within 24 h after birth. Similar results were noted pertaining to infant HBsAg seropositivity and HBV DNA seropositivity within 6–7 and 12 mo. Conclusions Lamivudine can significantly reduce the MTCT of HBsAg and HBV DNA of neonates during the third trimester of pregnancy without severe adverse events.

2303. Chronic Hepatitis B Virus Infection and Risk of Herpes Zoster: A Cohort Study

Background No cohort studies have evaluated the effect of hepatitis B virus (HBV) infection on the risk of herpes zoster. We investigated the association of HBV infection with the development of herpes zoster. Methods We performed a cohort study of 224,691 non-cirrhotic adult men and women free of herpes zoster at baseline who underwent serologic testing for hepatitis B surface antigen (HBsAg) and were followed annually or biennially for a median of 4.2 years. Incident cases of herpes zoster were ascertained using the Korean Health Insurance and Review Agency (HIRA) database. A Cox proportional hazard model was used to estimate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for incident herpes zoster according to HBsAg seropositivity status. Results During 830,073.4 person-years of follow-up, 11,061 cases of incident herpes zoster were identified. HBsAg seropositivity was inversely associated with the development of herpes zoster. After adjustment for possible confounders, the multivariable-adjusted hazard ratios (95% CI) for herpes zoster comparing HBsAg-positive to HBsAg-negative participants was 0.83 (0.75–0.93). Conclusion In a large cohort of Korean adults, HBsAg seropositivity was associated with lower risk of herpes zoster, suggesting that HBV seems to inhibit the reactivation of varicella-zoster virus. Disclosures All authors: No reported disclosures.

Hepatitis B Prevalence and Risk Factors in a Foreign-Born Asian and Pacific Islander Population at a Community Health Center in Hawai‘i

Hawai‘i has one of the highest rates of liver cancer in the United States. This is in large part due to undiagnosed chronic hepatitis B (CHB) infection among foreign-born Asian and Pacific Islanders (APIs). In order to estimate the prevalence of CHB infection among foreign-born APIs in Hawai‘i, the Hawai‘i State Department of Health conducted a cross-sectional study from August 2013 through August 2015 of patients of a federally qualified health center serving the largest population of medically underserved APIs in the state. Among 1261 patients surveyed, the prevalence of CHB infection (based on HBsAg seropositivity) was 5.6% (71/1259). No significant differences were detected by place of birth, age, or gender; however, the adjusted prevalence ratio of CHB infection was 6.0 times higher among persons reporting household contact with hepatitis B virus compared with those without such contact. Our findings underscore the need for targeted screening of at-risk individuals and their household contacts.

Clinical and Biochemical Characteristics and Aetiology of Asymptomatic Raised Alanine Aminotransferase in Newly Detected Diabetes and Impaired Glucose Tolerance Patients

Objectives: Clinical evaluation and identification of aetiology of asymptomatic raised serum alanine aminotransferase (ALT) level in newly detected adult diabetic and impaired glucose tolerance (IGT) patients.Methods: In this cross-sectional study, newly detected adult diabetic and IGT patients having asymptomatic raised serum ALT level of > 1.5 times of upper limit of normal were evaluated clinically and by laboratory tests.Results: Total number of patients was 120, which was 3.1% of all newly registered diabetic and IGT patients over the study period. Male were 74 and female 46. Diabetes mellitus (DM) was found in 93.3% cases and IGT in 6.7%. Mean age was 43.1 years, mean body weight was 64.5 kg and mean body mass index (BMI) was 25.5 kg/m2. Central (abdominal) obesity was found in 61.5% cases. Increased waist hip ratio was found in 86.3% cases. Hypertension and hepatomegaly were present in 35% and 5.8% cases respectively. Dyslipidaemia was found in 98.3% cases and 45% patients fulfilled criteria for metabolic syndrome. Regarding etiology, 76.7% cases had non-alcoholic fatty liver disease (NAFLD), 8.3% had HBsAg sero-positivity, 4.2% had anti-HCV seropositivity and 3.3% had both NAFLD and HBsAg seropositivity. In 7.5% cases no cause was found. Raised serum ALT level had a significant correlation with metabolic syndrome (p= 0.016) and increasing age (p= 0.008).Conclusion: Elevation of serum ALT is common in DM and IGT. NAFLD is the commonest cause followed by hepatitis B and C virus infection.J Bangladesh Coll Phys Surg 2015; 33(2): 70-74