Global prevalence of occult hepatitis B: A systematic review and meta‐analysis

Abstract

The study aimed to investigate the prevalence and risk factors associated with occult hepatitis B virus (HBV) infection (OBI) in the global population. We searched PubMed, Embase, CINAHL, Cochrane and Web of Science from database inception through 27 Dec, 2018. Studies reporting HBV‐DNA serological data in previously undiagnosed hepatitis B patients were included. The data were further categorized according to the presence of risk factors. After an initial screening of 2,325 records, we finally included 98 articles about the prevalence of OBI from 34 countries and regions. The OBI prevalence was 0.82% (95% CI:0.69–0.96) in the general population, 16.26% (95% CI:10.97–22.34) in HIV patients, 13.99% (95% CI:8.33–20.79) in patients with other liver diseases, 4.25% (95% CI:1.64–7.87) in haemodialysis patients and 5.14% (95% CI:2.26–9.01) patients with other risk factors. In conclusion, OBI prevalence varies significantly across different populations and nations, which deserve attention from the public health authorities. Our results generate further epidemiological data to identify the population with OBI, which has important clinical implications in finding these high‐risk populations to design preventive and management strategies.

Occult Hepatitis B Virus Infection: An Update

“…Interestingly, some studies have shown an association between transaminase elevation and the reappearance of serum HBV DNA in chronic hepatitis C patients, suggesting a possible impact of such transitory HBV reactivation on hepatocyte necrosis [6,7]. A similar, negative impact of OBI on the progression of CLD has been shown in patients with alcoholic or cryptogenic liver disease and-recently-also in patients with NAFLD [72,88,89,130,131]. In particular, one study assessed the presence of HBV viral genomes in liver tissues collected from HBsAg-negative morbidly obese patients at the time of bariatric surgery, revealing a prevalence of about 13% of OBI, which was an independent predictor of NASH and fibrosis in these subjects [89].…”

“…The worldwide epidemiology of OBI is quite variable, as it depends on many factors, such as the sensitivity of HBsAg and HBV DNA assays, whether there are risk factors for HBV exposure, the prevalence of HBV among the general population in the various geographic areas, the anti-HBV vaccination programs in the different countries, and the presence and severity of liver disease in the examined populations [ 71 , 72 ]. Indeed, most of the studies concerning OBI prevalence have been carried out on blood donors and on patients with liver disease; thus, they are not truly representative of the general population.…”

Prevalence of Cirrhosis/Advanced Fibrosis Among HBsAg-Negative and HBcAb-Positive US Adults: A Nationwide Population-Based Study

“…Health management after HBsAg loss is still very important for those populations. In addition, as HBV cannot be completely eradicated because of the persistence of covalently closed circular DNA (cccDNA) and integrated HBV DNA, another important consideration is occult HBV or HBV reactivation [ 17 , 18 ]. Occasionally, occult HBV or HBV reactivation may be mild or even asymptomatic, which results in occult HBV or HBV reactivation being easily neglected in clinical practice.…”

Low Risk of Occult Hepatitis B Infection among Vietnamese Blood Donors

“…However, it is important to point out that these data are largely derived from studies on Chinese populations, which may not be predictive of the OBI prevalence in Vietnam. Low levels of OBI could also be due to the sensitivity of the HBsAg test used, or good health care that reduces the risk of OBI transmission [32,33]. Furthermore, regionality and socioeconomic status have been shown to influence the discrepancy in HBV infections and OBI rates between populations [34].…”