Transmission of serologically silent hepatitis B virus along with hepatitis C virus in two cases of posttransfusion hepatitis

Abstract

The polymerase chain reaction (PCR) was used to investigate the presence of hepatitis B virus (HBV)-related DNA sequences in blood from three blood donors and two transfusion recipients who developed posttransfusion non-A, non-B hepatitis (NANBH). In the first case, the sole donor was positive for antibody to hepatitis B surface (HBs) and core (HBc) antigens and had elevated alanine aminotransferase (ALT) levels, while the recipient had no HBV serologic markers. Both the donor and the recipient had serologic markers of hepatitis C virus (HCV) and were found positive for HBV DNA and HCV RNA sequences by PCR. The second case involved two donors and one recipient. Serologic tests for conventional HBV markers were negative in all three individuals, but one of the donors had elevated ALT. HBV DNA sequences were detected by PCR in the serum of the recipient and of the donor with high ALT, but not in the serum of the donor with normal ALT. Anti-HCV was detected in the serum of the recipient and of the suspect donor but not in that of the donor with normal ALT. The sequences amplified in the S region and determined after cloning of PCR products for both donor-recipient pairs were indistinguishable from each other and identical to the sequence of the major HBV subtype of adw in the first case and ayw in the second case. Furthermore, for the second case, an identical single-point mutation was found in both the donor and the recipient. These data confirm the transmission of conserved HBV sequences together with HCV in posttransfusion NANBH.(ABSTRACT TRUNCATED AT 250 WORDS)

Occult hepatitis B virus infection in immunocompromised patients

“…Occult HBV infection has received much attention recently, since it has been detected in patients with hepatocarcinoma [18], in blood donors and transfused patients [19,20], and in patients infected with hepatitis C virus [21][22][23]. In chronic HCV patients on hemodialysis, the prevalence of occult HBV infection is not yet well known [22,24].…”

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

“…In antiHBc-positive patients, the prophylaxis with anti-HBV nucleos(t)ide analogues is indicated in hematopoietic stem cell transplantation and in onco-hematological diseases when high doses of corticosteroids and rituximab are used, whereas monitoring is indicated in all other clinical conditions or when rituximab-sparing schedules are used (Figure 2). The literature data have shown the efficacy of lamivudine in preventing HBV reactivation in these subsets of patients [17,43,61] . Also entecavir has been proposed in the prophylaxis of reactivation of OBI.…”

“…OBI has also been described as a serological condition characterized by the presence of hepatitis B core antigen (anti-HBc) in the absence of HBsAg and anti-HBs (isolated anti-HBc) [7,[11][12][13][14][15] . OBI may be observed in the window period of acute HBV infection [16] in blood donors and in recipients of blood and blood products [9,17,18] , in patients with HCV chronic infection [7,19] , in cryptogenic chronic hepatitis, in patients under pharmacological suppression of the immune system [20,21] and in those with immunodepression due to HIV infection; it has also been associated to the development of hepatocellular carcinoma [22][23][24][25][26][27][28][29][30] . It has been shown that the hepatitis B virus maintains its pro-oncogenic properties in OBI [31] and that its presence in patients with chronic hepatitis C is associated with a higher risk of disease progression and HCC development [32][33][34][35][36] and with a reduced response to alfa interferon treatment [37][38][39] .…”

Persistent hepatitis B virus infection in subjects without hepatitis B surface antigen: Clinically significant or purely “occult”?

“…The presence of complete infectious HBV particles in these patients was established using several complementary approaches: the transmission of hepatitis by HBV-DNA-positive sera into chimpanzees 13,14 ; post-transfusional and mother-tochild transmission of HBV DNA 14,15 ; the reinfection of liver grafts after liver transplantation for HBsAg-negative cirrhosis 16,17 ; and infection arising from HBsAg-negative organ donors. [18][19][20][21] These observations have been confirmed by reports of viral RNAs (including the viral pregenome) and covalently closed circular HBV DNA in the liver of these patients.…”