Occult Hepatitis B Virus Infection Prevalence Among Different Populations of Iran: A Systematic Review and Meta-Analysis

Abstract

Context: Various frequency rates of occult hepatitis B virus infection (OBI) are reported from different parts of Iran. This systematic review and meta-analysis aimed to characterize the OBI epidemiology in Iran and estimate the pooled prevalence among different populations. Evidence Acquisition: Nine international and Persian electronic databases, as well as some conference proceedings, were searched. Original cross-sectional studies up to December 2018 were included if they investigated the prevalence of OBI by the detection of serum hepatitis B virus surface antigen and hepatitis B virus nucleic acid in at least 30 samples selected with any sampling methods. Comprehensive meta-analysis software was used to analyze the data, and Cochran’s Q-test and I-square statistics were applied to assess the heterogeneity. Meta-regression analysis was performed to assess the impact of the year of study on the OBI frequency. A P value < 0.05 was considered as the level of significance. Results: Of 412 citations found in electronic sources and 35 relevant citations added by searching the gray literature, 83 non-duplicated non-overlapping studies were evaluated. A total of 55 documents comprising 14,485 individuals from 16 provinces met the inclusion criteria and were used in the analysis. The prevalence of OBI considerably varied in different parts of the country with the highest prevalence (63.1%) reported among the HIV-positive population in Fars province. The rates of the OBI prevalence were estimated at 0.06% (95% CI: 0.02 - 0.16%) among blood donors (BDs) regardless of their anti-HBc status, 7.90% (95% CI: 4.33 - 13.99%) among anti-HBc positive BDs, 2.49% (95% CI: 1.2 - 4.81%) among hemodialysis (HD) patients, 4.44% (95% CI: 1.56 - 12.02%) among HIV-positive patients, and 7.76% (95% CI: 4.57 - 12.86%) among HCV-positive patients. No significant trends were observed in OBI prevalence rates among different groups over time (P > 0.05). Conclusions: This review revealed high rates of OBI prevalence among high-risk populations in Iran. It is strongly suggested that occult hepatitis B be investigated among populations with a high chance of its occurrence in our country.

Prevalence of Overt and Occult Hepatitis B Virus Infection among HIV-Positive People Referring to Consultation Center for Behavioral Diseases, Kurdistan Province, Iran

“…Viral DNA was detected in 30% of high-risk people in Iran [15] . In a systematic and meta-analysis study in Iran, the prevalence of OBI was 0.06% among blood donors regardless of anti-HBc result and 7.90% among anti-HBc-positive donors [13] . In the present study, among 31 anti-HBc-positive and HBsAg-negative samples (suspected OBI), only one (3.22%) sample was positive for HBV DNA (confirmed seropositive OBI).…”

“…A systematic review and meta-analysis showed the high occurrence of OBI among Iranian high-risk people. Prevalence of OBI was variable in different regions of Iran, from zero to 63.1% in the HIV-positive people in Fars province [13] . However, knowledge about the prevalence of HBV among HIV-infected people in Iran is less, especially in the Kurdistan province.…”

Hepatitis B Vaccination Status in Dental Practitioners: Local Horrifying Report, National Considerable Issue, and Global Health Impact

“…In Iran, approximately 2-3% of people are carriers of the virus, and nearly 300,000 people are suffering from hepatitis, cirrhosis, or hepatocellular carcinoma. In Iran, 70-80% of chronic hepatitis results from HBV as the primary cause (2,(9)(10)(11).…”

High Prevalence of Occult Hepatitis B Virus Infection among Iranian Hemodialysis Patients

“…These patients might be positive or negative for the serological markers of previous infection. [1][2][3] Occult HBV infection usually occurs after acute self-limited or chronic hepatitis B in which HBsAg is absent or undetectable due to suppression of viral replication and HBsAg expression under the host immune responses or mutations in the S region of the genome and the production of the modified HBsAg that is unrecognizable by routinely used HBsAg detection assays. 4 In addition to the host and viral factors, hepatitis C virus (HCV) coinfection might have a role in the development of occult HBV infection through inhibition of HBV replication and HBsAg expression.…”