High incidence of hepatitis B infections among chronic hepatitis cases of unknown aetiology

Chemin, Isabelle; Zoulim, Fabien; Merle, Philippe; Arkhis, Ahmed; Chevallier, M.; Kay, Alan; Cova, Lucyna; Chevallier, Philippe; Mandrand, Bernard; Trépo, C.

doi:10.1016/s0168-8278(00)00100-8

Cited by 157 publications

(144 citation statements)

References 44 publications

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“…The PCR technique was performed with one fifth of the total nucleic acids extracted from 140ìl of serum (Qiagen), based on Chemin et al (2001) [20]. Genotype determination was performed through INNOLIPA (Imunogenetic, Belgium).…”

Section: Serological Examinationsmentioning

confidence: 99%

Serological markers of hepatitis A, B and C viruses in rural communities of the semiarid Brazilian Northeast

Almeida¹,

Tavares-Neto²,

Vitvitski³

et al. 2006

Braz J Infect Dis

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Section: Serological Examinationsmentioning

confidence: 99%

Serological markers of hepatitis A, B and C viruses in rural communities of the semiarid Brazilian Northeast

Almeida¹,

Tavares-Neto²,

Vitvitski³

et al. 2006

Braz J Infect Dis

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“…Therefore, viral DNA investigation must be performed, and sensitive techniques must be used since serum levels can be low [10].…”

mentioning

confidence: 99%

Occult B infection in the Brazilian northeastern region: a preliminary report

Almeida¹,

Tavares-Neto²,

Trépo

et al. 2008

Braz J Infect Dis

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A sentinel study on viral hepatitis is currently being carried out in the village of Cavunge in a semiarid rural region of the state of Bahia, northeastern Brazil. This study has identified individuals in whom anti-HBc IgG was the only serological marker for hepatitis B virus (HBV). This serological pattern may constitute evidence of occult HBV infection. This study Investigated the possibility of occult hepatitis B virus infection in individuals in a rural community who tested positive for anti-HBc IgG alone. A cross-sectional population-based study. ELISA III was performed on serum samples to test for serological viral markers, and ultrasensitive PCR (US-PCR) was used to assess viremia. Among the 1,536 serum samples, 3.6% (n=55) were positive for anti-HBc alone. Four years after this first serological survey, 31 of those 55 individuals (56.3%) were retested, and 11 (35.5%) remained anti-HBc positive alone. Two of these 31 (6.5%) were HBV-DNA positive based on US-PCR, with normal aminotransferase levels in both cases. Cases of occult hepatitis B infection were identified in this semiarid rural community of northeastern Brazil, where endemicity of HBV is moderate. Key-Words: Anti-HBc alone, hepatitis B virus, occult hepatitis B, ultrasensitive PCR.Approximately 400 million people worldwide are chronic hepatitis B carriers. Despite vaccination, serological tests performed in hemotherapy services, and programs for the prevention of sexually transmitted infections, the number of hepatitis B virus (HBV)-infected individuals remains high, with prevalence ranging from 0.1% to 20% [1].The serological marker most widely used to detect exposure to HBV is HBcAg IgG; however, this marker is unable to define the status of the HBV carrier [2]. In individuals in whom antibody against the core protein (anti-HBc IgG) is the only positive marker, there are various possible explanations for false-positive test results, including patients with past, resolved infection, in whom the antibody against hepatitis B surface antigen (anti-HBs) is not present, occult HBV infection due to mutation of the S gene, or very low viral replication [3]. In this last hypothesis, analysis for HBV-DNA is considered the most sensitive diagnostic method [4].Clearance of hepatitis B surface antigen (HBsAg) generally indicates seroconversion to anti-HBs and consequent remission of HBV infection [5]. However, several researchers have shown that seroconversion to anti-HBs is not necessarily indicative of virological cure. In this case, an occult, silent or latent hepatitis B infection may be characterized by presence of viral DNA alone, while the patient tests negative for HBsAg or anti-HBc [6]. A clear example is the diagnosis of this infection in patients with chronic hepatitis of undefined etiology (cryptogenic hepatitis), comorbid hepatitis C virus (HCV), HIV carriers, patients with chronic renal failure or patients with hepatocellular carcinoma [7,8]. There are also case reports of hepatitis B transmission following blood transfusion or organ donation...

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“…In any case, negativity for HBsAg by the ELISA test does not necessarily mean absence of infection, which can be detected by PCR due to its higher sensitivity compared to an ELISA test. Patients infected with HBV, who are co-in- fected with HCV, seem to have lower viral replication activity, indicating mutual interference and suggesting that HCV has a suppressive effect on HBV (20)(21)(22)(23)(24). In a recent study, 33 blood donors repetitively found to have anti-HBc alone were vaccinated against HBV infection, and 13 (39%) showed seroconversion 30 days after taking one dose of the HBV vaccine.…”

Section: Discussionmentioning

confidence: 99%

HBV vaccination of HCV-infected patients with occult HBV infection and anti-HBc-positive blood donors

Pereira

Gonçales

Silva

et al. 2006

Braz J Med Biol Res

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Anti-HBc positivity is a frequent cause of donation rejection at blood banks. Hepatitis B virus (HBV) infection may also occur in HBsAgnegative patients, a situation denoted occult infection. Similarly, very low levels of HBV-DNA have also been found in the sera of patients with chronic hepatitis C virus (HCV) infection, even in the absence of serum HBsAg. Initially we searched for HBV-DNA in serum of 100 blood donors and 50 HCV-infected patients who were HBsAg negative/anti-HBc positive by nested-PCR and by an HBV monitor commercial test for HBV-DNA. Anti-HBs seroconversion rates were measured in 100 blood donors and in 22 patients with chronic HCV infection after HBV vaccination to determine if the HBV vaccination could eliminate an occult HBV infection in these individuals. Occult HBV infection was detected in proportionally fewer blood donors (6/ 100 = 6%) than chronic hepatitis C patients (12/50 = 24%) (P < 0.05). We noted seroconversion in 6/6 (100%) HBV-DNA(+) and in 84/94 (89.4%) HBV-DNA(-) blood donors (P > 0.05). All subjects who were HBV-DNA(+) before the first dose of HBV vaccine (D1), became HBV-DNA(-) after D1, D2, and D3. Among 22 HCV-positive patients, 10 HBV-DNA(+) and 12 HBV-DNA(-), seroconversion was observed in 9/10 (90%) HBV-DNA(+) and in 9/12 (75%) HBV-DNA(-) subjects (P > 0.05). The disappearance of HBV-DNA in the majority of vaccinated patients suggests that residual HBV can be eliminated in patients with occult infection.

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High incidence of hepatitis B infections among chronic hepatitis cases of unknown aetiology

Cited by 157 publications

References 44 publications

Serological markers of hepatitis A, B and C viruses in rural communities of the semiarid Brazilian Northeast

Serological markers of hepatitis A, B and C viruses in rural communities of the semiarid Brazilian Northeast

Occult B infection in the Brazilian northeastern region: a preliminary report

HBV vaccination of HCV-infected patients with occult HBV infection and anti-HBc-positive blood donors

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