Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil

Branco, Fernanda; Mattos, Ângelo Alves de; Coral, Gabriela Perdomo; Vanderborght, Bart; Santos, Diogo Edele dos; França, Paulo Henrique Condeixa de; Alexandre, Cláudio Osmar Pereira

doi:10.1590/s0004-28032007000100013

Cited by 36 publications

(29 citation statements)

References 38 publications

(78 reference statements)

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“…Therefore, our results indicated that presence of HBV-DNA could cause an inhibitory influence on elevation of liver enzymes, and provides additional support for the opinion that HBV-DNA has inhibitory interference on HCV activity. Also, the result of normal liver enzymes in our patients with OBI were comparable to many studies that failed to demonstrate the association between OBI and elevation of liver enzymes in patients with HCV (17, 24, 27, 28). However, other studies reported a direct correlation between the presence of OBI and flare liver enzymes (29, 30).…”

Section: Discussionsupporting

confidence: 88%

Prevalence of Occult Hepatitis B Virus in Plasma and Peripheral Blood Mononuclear Cell Compartments of Patients WithChronic Hepatitis C Infection in Tehran-Iran

et al. 2013

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BackgroundOccult hepatitis B virus (HBV) infection (OBI) is frequently reported in patients with chronic hepatitis C virus (HCV) infection. An association between OBI and more liver damage, cirrhosis, hepatocellular carcinoma, and reduced response to interferon therapy in patients with HCV infection is suggested.ObjectivesThe aim of this study was to determine the prevalence of occult HBV, and evaluate its clinical influence on patients with chronic HCV.Patients and MethodsA cohort study including50 patients with positive results for HCV, and negative results for HBsAg tests was performed. The patients were divided into two groups: one group had positive results for both HCV and occult HBV tests (n = 18), and the other had positive results for HCV, but negative findings for occult HBV (n = 32). All were treated with PEG-IFN alpha-2a and Ribavirin. Presence of HCV RNA was followed in these patients.ResultsHBV-DNA was detected using nested-PCR in 20% of plasma and 32.6% of peripheral blood mononuclear cell (PBMC) compartments. No significant differences were observed between patients with and without occult HBV for sex, age, duration of HCV infection, histological markers, presence of anti-HBc, HCV viral load, and HCV genotype. The response rate was significantly higher in patients with positive results for HBV-DNA test compared to those with negative findings (100% vs. 71.9 %, P < 0.05).ConclusionsIn conclusion, occult HBV was found in 36% of patients with negative results for HBsAg, but positive results for HCV. Detection of HBV-DNA in both PBMCs and plasma together in comparison with plasma alone provided more true identification of OBI.The SVR rate was significantly higher in coinfected patients than mono-infected ones.

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Section: Discussionsupporting

confidence: 88%

Prevalence of Occult Hepatitis B Virus in Plasma and Peripheral Blood Mononuclear Cell Compartments of Patients WithChronic Hepatitis C Infection in Tehran-Iran

et al. 2013

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“…Meanwhile, we need to know more about the potential progression of occult hepatitis B, as well as its transmission, carcinogenesis [19] and association with hepatitis C [20].…”

Section: Discussionmentioning

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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“…[7844] It should be taken into consideration that most of these studies are cross sectional and therefore more precise cohort studies have to be performed to measure the real impact of occult HBV in patients with HCV linked chronic liver disease. [18]…”

Section: Severity and Histology Of Hcv Related Liver Diseasementioning

confidence: 99%

“…To the best of our knowledge, almost none of the studies report a relationship between silent HBV infection and high aminotransferases levels in patients suffering from chronic liver disease due to HCV infection[728404144] and it can be concluded that aminotransferase level in patients with chronic HCV infection cannot predict the presence of silent HBV replication or activation.…”

Section: Serum Aminotransferasesmentioning

confidence: 99%

Occult hepatitis B infection and its possible impact on chronic hepatitis C virus infection

Habibollahi

Safari

Daryani

et al. 2009

Saudi J Gastroenterol

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As a well-recognized clinical phenomenon, persistent detectable viral genome in liver or sera in the absence of other serological markers for active hepatitis B virus (HBV) replication is called occult HBV infection. The main mechanism through which occult infection occurs is not completely understood and several possible explanations, such as integration into human genome and maintenance in peripheral mononuclear cells, exist. Occult HBV infection has been reported in different populations, especially among patients with Hepatitis C (HCV) related liver disease. The probable impact of occult HBV in patients with chronic HCV infection has been previously investigated and the evidence suggests a possible correlation with lower response to anti-viral treatment, higher grades of liver histological changes, and also developing hepatocellular carcinoma. However, in the absence of conclusive results, further studies should be conducted to absolutely assess the impact of occult HBV contamination on the HCV related liver disease.

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Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil

Cited by 36 publications

References 38 publications

Prevalence of Occult Hepatitis B Virus in Plasma and Peripheral Blood Mononuclear Cell Compartments of Patients WithChronic Hepatitis C Infection in Tehran-Iran

Prevalence of Occult Hepatitis B Virus in Plasma and Peripheral Blood Mononuclear Cell Compartments of Patients WithChronic Hepatitis C Infection in Tehran-Iran

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

Occult hepatitis B infection and its possible impact on chronic hepatitis C virus infection

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