Hepatitis B variants among Egyptian patients undergoing hemodialysis

Abstract

Hepatitis B virus (HBV) infection is a serious nosocomial infection that affectspatients 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.

The prevalence and associated factors of hepatitis B and C virus in hemodialysis patients in Africa: A systematic review and meta-analysis

“…The minimum prevalence was 0.8% (Libya) [ 25 ] and 2.3% (Nigeria) [ 23 ] for HBV and HCV, respectively. On the other hand, the maximum prevalence of HBV and HCV was 60.7% (Egypt) [ 59 ] and 60.9% (Egypt) [ 43 ], respectively. A total of 23 studies reported the prevalence of HBV in HD patients.…”

The Guerilla Tactics of Hepatitis B Virus in Hemodialysis: Fighting a Stubborn Foe

“…The presence of these mutant strains has been linked to occult HBV infection in dialysis facilities, and they present with highly variable clinical manifestations, making detection difficult without measuring HBV DNA using quantitative polymerase chain reaction (PCR). 9 , 10 , 11 Although low-level occult HBV viremia or exposure to mutant HBV does not always result in clinically significant hepatic disease in chronic kidney failure, it remains a real safety concern, particularly with the risk for HBV reactivation after kidney transplantation. 9 …”

“…A second consideration is the heterogeneity of serologic profiles for occult HBV infections, whether related to mutant strains or low levels of viremia for wild-type virus. 9 , 10 , 11 , 13 , 14 About 20% of occult HBV sera are negative for all serologic markers of HBV infection. 13 Fifty percent are positive for hepatitis B core antibody (HBcAb) and 35% are positive for hepatitis B surface antibody (HBsAb) with or without HBcAb.…”