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Pondé RADA, Amorim GDSP. Exchanges in the 'a' determinant of the hepatitis B virus surface antigen revisited. Virology 2024; 599:110184. [PMID: 39127000 DOI: 10.1016/j.virol.2024.110184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/02/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
The hepatitis B virus surface antigen's (HBsAg) 'a' determinant comprises a sequence of amino acid residues located in the major hydrophilic region of the S protein, whose exchanges are closely associated with compromising the antigenicity and immunogenicity of that antigen. The HBsAg is generally present in the bloodstream of individuals with acute or chronic hepatitis B virus (HBV) infection. It is classically known as the HBV infection marker, and is therefore the first marker to be investigated in the laboratory in the clinical hypothesis of infection by this agent. One of the factors that compromises the HBsAg detection in the bloodstream by the assays adopted in serological screening in both clinical contexts is the loss of S protein antigenicity. This can occur due to mutations that emerge in the HBV genome regions that encode the S protein, especially for its immunodominant region - the 'a' determinant. These mutations can induce exchanges of amino acid residues in the S protein's primary structure, altering its tertiary structure and the antigenic conformation, which may not be recognized by anti-HBs antibodies, compromising the infection diagnosis. In addition, these exchanges can render ineffective the anti-HBs antibodies action acquired by vaccination, compromise the effectiveness of the chronically HBV infected patient's treatment, and also the HBsAg immunogenicity, by promoting its retention within the cell. In this review, the residues exchange that alter the S protein's structure is revisited, as well as the mechanisms that lead to the HBsAg antigenicity loss, and the clinical, laboratory and epidemiological consequences of this phenomenon.
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Affiliation(s)
- Robério Amorim de Almeida Pondé
- Secretaria de Estado da Saúde -SES/Superintendência de Vigilância Em Saúde-SUVISA/GO, Gerência de Vigilância Epidemiológica de Doenças Transmissíveis-GVEDT/Coordenação de Análises e Pesquisas-CAP, Goiânia, Goiás, Brazil; Laboratory of Human Virology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Spontaneous reactivation of hepatitis B virus with S gene mutations in an elderly patient with diabetic nephropathy. Clin J Gastroenterol 2020; 13:914-919. [PMID: 32519312 DOI: 10.1007/s12328-020-01149-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/02/2020] [Indexed: 12/30/2022]
Abstract
Generally, reactivation of hepatitis B virus (HBV) infection is induced by the administration of immunosuppressants or anticancer agents, but reactivation without such drugs has rarely been reported. Here we report an elder case with spontaneous reactivation of HBV replication accompanied by hepatitis B surface antigen (HBsAg) mutations. A 69-year-old man with a history of diabetes mellitus and chronic kidney disease (CKD) was found to be positive for HBsAg (0.072 IU/ml) in June 2018. In May 2019, marked hepatic dysfunction and increased HBsAg (2533.2 IU/ml) were observed when he visited the hospital due to diarrhea and worsening of CKD. At that time, hepatitis B surface antibody (HBsAb) was positive (268.9 mIU/ml) and HBV DNA was 6.0 log IU/ml. After treatment with entecavir, HBV DNA and HBsAg rapidly decreased. Full-genome HBV sequence analysis revealed that the patient was infected with HBV of subgenotype B1 and it had an "a" determinant mutation M133L in the S gene coding HBsAg. Notably, both HBsAg and HBsAb were positive at the time of HBV reactivation, suggesting that the HBV with these mutations escaped from neutralization by HBsAb. This case suggests that immune escape mutations could play an important role in spontaneous HBV reactivation.
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Genetic polymorphisms of HLA-DP and isolated anti-HBc are important subsets of occult hepatitis B infection in Indonesian blood donors: a case-control study. Virol J 2017; 14:201. [PMID: 29061159 PMCID: PMC5654084 DOI: 10.1186/s12985-017-0865-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/11/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Occult hepatitis B infection (OBI) is defined as the presence of hepatitis B virus (HBV) DNA in the serum and/or liver in HBsAg-negative individuals. OBI is associated with the risk of viral transmission, especially in developing countries, and with progressive liver disease and reactivation in immunosuppressive patients. The objective of this study was to evaluate the relation of OBI to HLA-DP single nucleotide polymorphisms (SNPs) encoding antigen-binding sites for the immune response to HBV infection. As HLA-DP variants affect the mRNA expression of HLA-DPA1 and HLA-DPB1 in the liver, we hypothesised that high levels of HLA-DPA1 and HLA-DPB1 expression favour OBI development. METHODS The study enrolled 456 Indonesian healthy blood donors (HBsAg negative). OBI was defined as the presence of HBV-DNA in at least two of four open reading frames (ORFs) of the HBV genome detected by nested PCR. SNPs in HLA-DPA1 (rs3077) and HLA-DPB1 (rs3135021, rs9277535, and rs2281388) were genotyped using real-time Taqman® genotyping assays. RESULTS Of 122 samples positive for anti-HBs and/or anti-HBc, 17 were determined as OBI. The minor allele in rs3077 was significantly correlated with OBI [odds ratio (OR) = 3.87, 95% confidence interval (CI) = 1.58-9.49, p = 0.0015]. The prevalence of the minor allele (T) was significantly higher in subjects with OBI than in those without (59% and 33%, respectively). The combination of haplotype markers (TGA for rs3077-rs3135021-rs9277535) was associated with increased risk of OBI (OR = 4.90, 95%CI = 1.12-21.52 p = 0.038). The prevalence of OBI was highest in the isolated anti-HBc group among the three seropositive categories: anti-HBs <500 mIU/ml, anti-HBs ≥500 mIU/ml, and isolated anti-HBc (29.41%, p = 0.014). CONCLUSION Genetic variants of HLA-DP and the presence of anti-HBc are important predictors of OBI in Indonesian blood donors. TRIAL REGISTRATION Ref: KE/FK/194/EC; registered 01 March 2013. Continuing approval Ref: KE/FK/536/EC; registered 12 May 2014.
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Ostankova YV, Semenov AV, Burkitbayev ZK, Savchuk TN, Totolian AA. RESULTS OF GENOTYPING HEPATITIS VIRUS B IN HBsAg-NEGATIVE BLOOD DONORS IN ASTANA, KAZAKHSTAN. ACTA ACUST UNITED AC 2017. [DOI: 10.15789/2220-7619-2017-4-383-392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gunardi H, Iskandar MY, Turyadi, Ie SI, Dwipoerwantoro PG, Gani RA, Muljono DH. Hepatitis B virus infection in children of HBV-related chronic liver disease patients: a study of intra-familial HBV transmission. Hepatol Int 2016; 11:96-104. [PMID: 27624502 DOI: 10.1007/s12072-016-9764-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/25/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND HBV-infected patients are potential sources of intra-familial transmission. We studied HBV transmission and molecular characteristics within families of HBV-related chronic liver disease (CLD) patients. METHODS Family members [index cases (ICs), spouses, and 1-18-year-old children] of HBV-related CLD patients were tested for HBsAg, anti-HBc, and anti-HBs. HBsAg-positive subjects were tested for HBeAg/anti-HBe. Anti-HBc-positive children together with their family members were further investigated for HBV DNA. Sequences of positive isolates were analyzed over surface, precore (PC) and basal core promoter (BCP) regions. RESULTS Among 94 children of 46 ICs, the prevalence of HBsAg, anti-HBc, and anti-HBs was 10 (10.6 %), 19 (20.2 %), and 46 (48.9 %), respectively. Thirty-eight (40.4 %) children were seronegative, indicating susceptibility to HBV infection. HBV DNA was identified in all ICs, 4 spouses, and 16 children. Having both parents with HBsAg positive and at least two HBV carriers in the households were significant risk factors of intra-familial transmission. HBV genotype/subtype distributions were comparable between children and ICs/spouses, with predominance of genotype B. The majority of HBV DNA sequences found in children were identical to their corresponding ICs-particularly mothers-including mutation patterns in the surface, PC, and BCP regions. Recognized mutations associated with HBsAg detection and/or vaccination failure, T140I, T143S/M, G145R, and Y161F, were identified in 20 subjects; while mutations linked to HBeAg-defective variants, PC G1896A and BCP A1762T/G1764A, were found in 7 and 11 subjects, respectively. CONCLUSIONS Children of HBV-related CLD patients were at increased risk of HBV infection through multi-modal transmission routes despite negative parental HBsAg and HBeAg status.
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Affiliation(s)
- Hartono Gunardi
- Department of Child Health, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Melanie Y Iskandar
- Department of Child Health, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Turyadi
- Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta, 10430, Indonesia
| | - Susan I Ie
- Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta, 10430, Indonesia
| | | | - Rino A Gani
- Department of Internal Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - David H Muljono
- Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta, 10430, Indonesia. .,Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. .,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Lusida MI, Juniastuti, Yano Y. Current hepatitis B virus infection situation in Indonesia and its genetic diversity. World J Gastroenterol 2016; 22:7264-7274. [PMID: 27621573 PMCID: PMC4997646 DOI: 10.3748/wjg.v22.i32.7264] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/27/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Indonesia has a moderate to high endemicity of hepatitis B virus (HBV) infection. The risk for chronic HBV infection is highest among those infected during infancy. Since 1997, hepatitis B (HepB) vaccination of newborns has been fully integrated into the National Immunization Program. Although HBV infection has been reduced by the universal newborn HepB immunization program, it continues to occur in Indonesia. The low birth dose coverage and the presence of vaccine escape mutants might contribute to this endemicity among children. Although limited information is available for an analysis of occult HBV infection (OBI), several variations and substitutions in the pre-S/S region have been detected in Indonesian HBV strains. Additionally, persistent infection and disease progression of chronic hepatitis B are related to not only viral factors but also the host genome. Indonesia is one of the most ethnically heterogeneous nations, with Javanese and Sundanese as the two highest ethnic groups. This multi-ethnicity makes genomic research in Indonesia difficult. In this article, we focused on and reviewed the following aspects: the current hepatitis B immunization program and its efficacy, OBI, HBV infection among high-risk patients, such as hemodialysis patients, and research regarding the host genome in Indonesia.
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Purwono PB, Juniastuti, Amin M, Bramanthi R, Nursidah, Resi EM, Wahyuni RM, Yano Y, Soetjipto, Hotta H, Hayashi Y, Utsumi T, Lusida MI. Hepatitis B Virus Infection in Indonesia 15 Years After Adoption of a Universal Infant Vaccination Program: Possible Impacts of Low Birth Dose Coverage and a Vaccine-Escape Mutant. Am J Trop Med Hyg 2016; 95:674-9. [PMID: 27402524 DOI: 10.4269/ajtmh.15-0121] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/12/2016] [Indexed: 12/14/2022] Open
Abstract
A universal hepatitis B vaccination program for infants was adopted in Indonesia in 1997. Before its implementation, the prevalence of hepatitis B surface antigen (HBsAg)-positive individuals in the general population was approximately 5-10%. The study aimed to investigate the hepatitis B virus (HBV) serological status and molecular profile among children, 15 years after adoption of a universal infant vaccination program in Indonesia. According to the Local Health Office data in five areas, the percentages of children receiving three doses of hepatitis B vaccine are high (73.9-94.1%), whereas the birth dose coverage is less than 50%. Among 967 children in those areas, the seropositive rate of HBsAg in preschool- and school-aged children ranged from 2.1% to 4.2% and 0% to 5.9%, respectively. Of the 61 HBV DNA-positive samples, the predominant genotype/subtype was B/adw2 Subtype adw3 was identified in genotype C for the first time in this population. Six samples (11.5%) had an amino acid substitution within the a determinant of the S gene region, and one sample had T140I that was suggested as a vaccine-escape mutant type. The low birth dose coverage and the presence of a vaccine-escape mutant might contribute to the endemicity of HBV infection among children in Indonesia.
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Affiliation(s)
- Priyo Budi Purwono
- Department of Microbiology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia. Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Juniastuti
- Department of Microbiology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia. Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Mochamad Amin
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | | | - Nursidah
- Bahteramas Hospital, Kendari, Indonesia
| | | | - Rury Mega Wahyuni
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Yoshihiko Yano
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Soetjipto
- Department of Biochemistry, Faculty of Medicine, Airlangga University, Surabaya, Indonesia. Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Hak Hotta
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitake Hayashi
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takako Utsumi
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia. Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Maria Inge Lusida
- Department of Microbiology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia. Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia.
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Characterisation and follow-up study of occult hepatitis B virus infection in anti-HBc-positive qualified blood donors in southern China. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 15:6-12. [PMID: 27416568 DOI: 10.2450/2016.0268-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/28/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Most major Chinese blood centres look for hepatitis B surface antigen (HBsAg) and perform nucleic acid testing to screen blood for hepatitis B virus infection. The search for antibodies to the core of hepatitis B virus (anti-HBc) has not been implemented because it would lead to a high rate of discarded blood units. The aim of this study was to evaluate the prevalence of occult HBV infection among anti-HBc-positive qualified blood donors in southern China. MATERIALS AND METHODS We tested anti-HBc-positive blood donations negative for HBsAg and HBV DNA by standard NAT from Shenzhen for the presence of HBV DNA by sensitive nested and quantitative polymerase chain reactions. Anti-HBs titres were quantified. HBV DNA-positive donors were traced and followed-up. RESULTS Of the 1,033 qualified donors, 47.4% (95% CI: 44.4 to 50.5%) carried anti-HBc as evidence of exposure to HBV. The rate of anti-HBc positivity increased steadily with age, ranging from 32.6% in the age group <30 years to 69.8% in the age group <50 years (p<0.001). Of the 1,033 donors, 777 (75.2%; 95% CI: 72.4 to 77.8%) carried anti-HBs (>10 IU/L). HBV DNA was detected in 14 donors who were anti-HBc-positive, HBsAg-negative and negative by routine NAT. Seven of those 14 specimens had an anti-HBs titre above 100 mIU/mL. The prevalence of OBI in anti-HBc-positive qualified blood donors was 2.86% (95% CI: 1.57 to 4.75%). Eight of the 14 OBI cases were genotype B and one was genotype C; 7/14 cases were followed-up, one case converted to anti-HBe. HBV DNA became undetectable in all follow-up samples. DISCUSSION A small proportion of anti-HBc-positive qualified donors carry HBV DNA after HBsAg and NAT screening. This finding suggests the possibility of HBV transmission from asymptomatic donors, especially in areas of high HBV prevalence. More sensitive NAT rather than anti-HBc testing should be considered to improve blood safety.
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Zhang Z, Zhang L, Dai Y, Zhang Y, Li J, Li X. Occult hepatitis B virus infection: influence of S protein variants. Virol J 2016; 13:10. [PMID: 26786229 PMCID: PMC4717550 DOI: 10.1186/s12985-016-0464-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 01/07/2016] [Indexed: 02/08/2023] Open
Abstract
Background In occult hepatitis B viral infection (OBI), the persistence of hepatitis B virus (HBV) DNA is associated with a lack of hepatitis B surface antigen (HBsAg). To assess the possible role of HBsAg immune escape variants in OBI patients, variability in the HBV S gene was evaluated for OBI patients as well as chronic HBV infection patients from the same families. Methods We selected 17 HBV DNA-positive/HBsAg-negative patients (OBI group) and 15 HBV DNA- and HBsAg-positive patients from OBI families (control group). The S gene was amplified and cloned, and at least 15 clones per patient were sequenced and analyzed. Results Although the incidence of stop codon mutations within the S region was higher in the OBI group (13.6 %) than in the control group (1.5 %, P < 0.001), this type of mutation, together with insertion and deletion mutations, was prevalent in only three OBI patients. In the major hydrophilic region (MHR), a median of 0.75 residues were altered in every 100 residues for the OBI patients, whereas 0.95 out of 100 residues were changed in the control group (P = 0.428). Furthermore, some variants that are generally considered immune escape variants, such as mutations at positions s145, s147, and s123, were only observed in less than 5 % of all the clones sequenced, in either OBI or control group. Conclusions Our data suggest that HBsAg variants may not play a major role in OBI pathogenesis.
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Affiliation(s)
- Zhenhua Zhang
- Department of Infectious Diseases, the First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China. .,School of Pharmacy, Anhui Medical University, Hefei, China.
| | - Ling Zhang
- Department of Infectious Diseases, the First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China.
| | - Yu Dai
- Department of Infectious Diseases, the First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China.
| | - Yafei Zhang
- Department of Infectious Diseases, the First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China.
| | - Jun Li
- School of Pharmacy, Anhui Medical University, Hefei, China.
| | - Xu Li
- Department of Infectious Diseases, the First Affiliated Hospital, Anhui Medical University, Hefei, 230022, China.
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MEILANI MEILANI, UTSUMI TAKAKO, JUNIASTUTI JUNIASTUTI, AMIN MOCHAMAD, SOETJIPTO SOETJIPTO, HAYASHI YOSHITAKE, INGE LUSIDA MARIA. High Prevalence of Occult Hepatitis B Infection (OBI) and its Molecular Characteristics among Pregnant Women in Surabaya, Indonesia. MICROBIOLOGY INDONESIA 2016. [DOI: 10.5454/mi.10.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mortensen E, Kamali A, Schirmer PL, Lucero-Obusan C, Winston CA, Oda G, Winters MA, Durfee J, Martinello RA, Davey VJ, Holodniy M. Are current screening protocols for chronic hepatitis B virus infection adequate? Diagn Microbiol Infect Dis 2015; 85:159-67. [PMID: 27009896 DOI: 10.1016/j.diagmicrobio.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 11/30/2015] [Accepted: 12/14/2015] [Indexed: 12/15/2022]
Abstract
Chronic hepatitis B virus (HBV) infection screening usually includes only HBV surface antigen (HBsAg) testing; HBV core and surface antibody (anti-HBc, anti-HBs) assays, indicating resolved infection and immunity, are not routinely performed. Yet, serum HBV DNA is measurable in approximately 10% of HBsAg-negative/anti-HBc-positive cases, representing occult HBV infection (OBI). Patient blood samples from 2 Veterans Affairs medical center look-back investigations were screened for HBV infection using HBsAg enzyme immunoassays. Supplementary testing included anti-HBc and anti-HBs enzyme immunoassays. For anti-HBc-positive samples, HBV DNA testing was performed. Background OBI prevalence was further estimated at these 2 facilities based on HBV serology testing results from 1999-2012. Finally, a literature review was performed to determine OBI prevalence in the published literature. Of 1887 HBsAg-negative cohort patients, 98 (5.2%) were anti-HBc positive/anti-HBs negative; and 175 (9.3%), anti-HBc positive/anti-HBs positive. Six of 273 were HBV DNA positive, representing 0.3% of the total tested and 2.2% who were anti-HBc positive/anti-HBs negative or anti-HBc positive/anti-HBs positive. Among 32,229 general population veterans at these 2 sites who had any HBV testing, 4/108 (3.7%) were HBV DNA positive, none of whom were part of the cohort. In 129 publications with HBsAg-negative patients, 1817/1,209,426 (0.15%) had OBI. However, excluding blood bank studies with greater than 1000 patients, the OBI rate increased to 1800/17,893 (10%). OBI is not rare and has implications for transmission and disease detection. HBsAg testing alone is insufficient for detecting all chronic HBV infections. These findings may impact blood donation, patient HBV screening, follow-up protocols for patients assumed to have cleared the infection, and initiation of immunosuppression in patients with distant or undetected HBV.
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Affiliation(s)
- Eva Mortensen
- VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA
| | - Amanda Kamali
- VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA
| | - Patricia L Schirmer
- Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | | | | | - Gina Oda
- Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Mark A Winters
- VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA
| | - Janet Durfee
- Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Richard A Martinello
- Office of Public Health, Department of Veterans Affairs, Washington, DC, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Victoria J Davey
- Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Mark Holodniy
- VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA; Office of Public Health, Department of Veterans Affairs, Washington, DC, USA.
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Yano Y, Utsumi T, Lusida MI, Hayashi Y. Hepatitis B virus infection in Indonesia. World J Gastroenterol 2015; 21:10714-20. [PMID: 26478663 PMCID: PMC4600573 DOI: 10.3748/wjg.v21.i38.10714] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/14/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Approximately 240 million people are chronically infected with hepatitis B virus (HBV), 75% of whom reside in Asia. Approximately 600000 of infected patients die each year due to HBV-related diseases or hepatocellular carcinoma (HCC). The endemicity of hepatitis surface antigen in Indonesia is intermediate to high with a geographical difference. The risk of HBV infection is high in hemodialysis (HD) patients, men having sex with men, and health care workers. Occult HBV infection has been detected in various groups such as blood donors, HD patients, and HIV-infected individuals and children. The most common HBV subgenotype in Indonesia is B3 followed by C1. Various novel subgenotypes of HBV have been identified throughout Indonesia, with the novel HBV subgenotypes C6-C16 and D6 being successfully isolated. Although a number of HBV subgenotypes have been discovered in Indonesia, genotype-related pathogenicity has not yet been elucidated in detail. Therefore, genotype-related differences in the prognosis of liver disease and their effects on treatments need to be determined. A previous study conducted in Indonesia revealed that hepatic steatosis was associated with disease progression. Pre-S2 mutations and mutations at C1638T and T1753V in HBV/B3 have been associated with advanced liver diseases including HCC. However, drug resistance to lamivudine, which is prominent in Indonesia, remains obscure. Although the number of studies on HBV in Indonesia has been increasing, adequate databases on HBV infection are limited. We herein provided an overview of the epidemiology and clinical characteristics of HBV infection in Indonesia.
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Ie SI, Turyadi, Sidarta E, Sadhewa A, Purnomo GA, Soedarmono YSM, Pattiiha MZ, Thedja MD, Harahap AR, Muljono DH. High Prevalence of Hepatitis B Virus Infection in Young Adults in Ternate, Eastern Indonesia. Am J Trop Med Hyg 2015; 93:1349-55. [PMID: 26392157 DOI: 10.4269/ajtmh.15-0331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/05/2015] [Indexed: 12/29/2022] Open
Abstract
The incidence of hepatitis B virus (HBV) infection has been declining thanks to the universal hepatitis B infant immunization program. Nevertheless, young adults born before the program implementation might have acquired HBV in early childhood or remain susceptible to infection. This study aimed to evaluate hepatitis B epidemiology in asymptomatic young adult population in Ternate, eastern Indonesia. Serum samples of 376 subjects (aged 17-25, mean 19.82 ± 1.69 years; male/female 138/238) were screened for HBV parameters serologically (HBV surface antigen [HBsAg]; its antibody [anti-HBs]; anti-core antigen [anti-HBc]), and molecularly (HBV DNA). HBsAg, anti-HBc, anti-HBs, and HBV DNA prevalence were 15.7%, 36.2%, 24.2%, and 27.9%, respectively, with male predominance. Of all subjects, 13.0% were HBsAg negative with detectable HBV DNA (occult hepatitis B [OHB]), and 56.4% showed negativity for all seromarkers. This population showed high hepatitis B prevalence with substantial occurrence of OHB. However, a high percentage of the population were still susceptible and at risk of HBV infection. This study emphasizes the necessity to improve prevention strategies to screen and manage HBV carriers, including the adoption of catch-up or booster vaccination targeted to young adult populations. Investigations on the roles of host-virus interactions associated with OHB and its implications are warranted.
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Affiliation(s)
- Susan Irawati Ie
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Turyadi
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Erick Sidarta
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Arkasha Sadhewa
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Gludhug Ariyo Purnomo
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Yuyun S M Soedarmono
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Mochtar Zein Pattiiha
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Meta Dewi Thedja
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Alida R Harahap
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
| | - David H Muljono
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; School of Life Sciences and Technology, Bandung Institute of Technology, Bandung, Indonesia; Central Blood Center, Indonesian Red Cross, Jakarta, Indonesia; Department of Internal Medicine, Ternate General Hospital, Ternate, Maluku, Indonesia; Department of Clinical Pathology, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, New South Wales, Australia
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14
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Thedja MD, Muljono DH, Ie SI, Sidarta E, Turyadi, Verhoef J, Marzuki S. Genogeography and Immune Epitope Characteristics of Hepatitis B Virus Genotype C Reveals Two Distinct Types: Asian and Papua-Pacific. PLoS One 2015; 10:e0132533. [PMID: 26162099 PMCID: PMC4498642 DOI: 10.1371/journal.pone.0132533] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 06/15/2015] [Indexed: 12/18/2022] Open
Abstract
Distribution of hepatitis B virus (HBV) genotypes/subgenotypes is geographically and ethnologically specific. In the Indonesian archipelago, HBV genotype C (HBV/C) is prevalent with high genome variability, reflected by the presence of 13 of currently existing 16 subgenotypes. We investigated the association between HBV/C molecular characteristics with host ethnicity and geographical distribution by examining various subgenotypes of HBV/C isolates from the Asia and Pacific region, with further analysis on the immune epitope characteristics of the core and surface proteins. Phylogenetic tree was constructed based on complete HBV/C genome sequences from Asia and Pacific region, and genetic distance between isolates was also examined. HBV/C surface and core immune epitopes were analyzed and grouped by comparing the amino acid residue characteristics and geographical origins. Based on phylogenetic tree and geographical origins of isolates, two major groups of HBV/C isolates—East-Southeast Asia and Papua-Pacific—were identified. Analysis of core and surface immune epitopes supported these findings with several amino acid substitutions distinguishing the East-Southeast Asia isolates from the Papua-Pacific isolates. A west-to-east gradient of HBsAg subtype distribution was observed with adrq+ prominent in the East and Southeast Asia and adrq- in the Pacific, with several adrq-indeterminate subtypes observed in Papua and Papua New Guinea (PNG). This study indicates that HBV/C isolates can be classified into two types, the Asian and the Papua-Pacific, based on the virus genome diversity, immune epitope characteristics, and geographical distribution, with Papua and PNG as the molecular evolutionary admixture region in the switching from adrq+ to adrq-.
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Affiliation(s)
- Meta Dewi Thedja
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Eijkman Winkler Institute, University Medical Centre (UMC) Utrecht, Utrecht, The Netherlands
| | - David Handojo Muljono
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Erick Sidarta
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Turyadi
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Jan Verhoef
- Eijkman Winkler Institute, University Medical Centre (UMC) Utrecht, Utrecht, The Netherlands
| | - Sangkot Marzuki
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia; Department of Medicine, Monash Medical Centre, Monash University, Clayton, Victoria, Australia
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15
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Darmawan E, Turyadi, El-Khobar KE, Nursanty NKD, Thedja MD, Muljono DH. Seroepidemiology and occult hepatitis B virus infection in young adults in Banjarmasin, Indonesia. J Med Virol 2014; 87:199-207. [PMID: 25521058 DOI: 10.1002/jmv.24045] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) infection remains a public health problem in Indonesia. There has been limited data regarding HBV infection in young adult population. This study aimed to evaluate the seroepidemiology of HBV infection and characterize occult HBV variants in healthy young adults in Banjarmasin, Indonesia, who were born before the implementation of the universal infant hepatitis B vaccination. Serum samples of 195 healthy young adults were tested for HBsAg, anti-HBc, and anti-HBs. The prevalence of HBsAg, anti-HBc, and anti-HBs was 9 (4.6%), 62 (31.8%), and 96 (49.2%), respectively. Seventy four (37.9%) samples were seronegative for all three parameters, indicating the susceptibility to HBV infection. Among 66 samples positive for HBsAg and/or anti-HBc, 13 (19.7%) were HBV DNA positive; of these, four were HBsAg positive and nine were HBsAg negative, and categorized as occult HBV infection. Most occult HBV cases had high-level anti-HBs (>100 IU/l), suggesting that blood with positive anti-HBs and anti-HBc could not be regarded as noninfectious. Thirteen amino acid substitutions were identified: T126S, P127S, Q129R, T131N, M133T, and Y161S in the HBsAg-positive group; P120T, T126I, G145S, Y161F, E164V, and V168F in the occult-HBV group; and T143S in both groups. More studies are required to provide data on the prevalence and characteristics of mutants to ensure reliable diagnosis. The occult HBV infection, combined with the HBsAg prevalence, could indicate the high HBV carriage among young adults in this area. The high percentage of individuals susceptible to HBV infection reiterates the need for catch-up immunization strategies targeted at young adults.
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Affiliation(s)
- Erica Darmawan
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
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16
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Powell EA, Gededzha MP, Rentz M, Rakgole NJ, Selabe SG, Seleise TA, Mphahlele MJ, Blackard JT. Mutations associated with occult hepatitis B in HIV-positive South Africans. J Med Virol 2014; 87:388-400. [PMID: 25164924 DOI: 10.1002/jmv.24057] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2014] [Indexed: 12/16/2022]
Abstract
Occult hepatitis B is characterized by the absence of hepatitis B surface antigen (HBsAg) but the presence of HBV DNA. Because diagnosis of hepatitis B virus (HBV) typically includes HBsAg detection, occult HBV remains largely undiagnosed. Occult HBV is associated with increased risk of hepatocellular carcinoma, reactivation to chronic HBV during immune suppression, and transmission during blood transfusion and liver transplant. The mechanisms leading to occult HBV infection are unclear, although viral mutations are likely a significant factor. In this study, sera from 394 HIV-positive South Africans were tested for HBV DNA and HBsAg. For patients with detectable HBV DNA, the overlapping surface and polymerase open reading frames (ORFs) were sequenced. Occult-associated mutations-those mutations found exclusively in individuals with occult HBV infection but not in individuals with chronic HBV infection from the same cohort or GenBank references-were identified. Ninety patients (22.8%) had detectable HBV DNA. Of these, 37 had detectable HBsAg, while 53 lacked detectable surface antigen. The surface and polymerase ORFs were cloned successfully for 19 patients with chronic HBV and 30 patients with occult HBV. In total, 235 occult-associated mutations were identified. Ten occult-associated mutations were identified in more than one patient. Additionally, 15 amino acid positions had two distinct occult-associated mutations at the same residue. Occult-associated mutations were common and present in all regions of the surface and polymerase ORFs. Further study is underway to determine the effects of these mutations on viral replication and surface antigen expression in vitro.
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Affiliation(s)
- Eleanor A Powell
- Division of Digestive Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio
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17
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Rinonce HT, Yano Y, Utsumi T, Heriyanto DS, Anggorowati N, Widasari DI, Lusida MI, Soetjipto, Prasanto H, Hotta H, Hayashi Y. Hepatitis B and C virus infection among hemodialysis patients in Yogyakarta, Indonesia: Prevalence and molecular evidence for nosocomial transmission. J Med Virol 2013; 85:1348-61. [PMID: 23919229 DOI: 10.1002/jmv.23581] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hemodialysis patients are at an increased risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. However, the prevalence of hepatitis viral infection and its genotype distribution among hemodialysis patients in Indonesia are unclear. In order to investigate these issues and the possibility of nosocomial transmission, 161 hemodialysis patients and 35 staff members at one of the hemodialysis unit in Yogyakarta, Indonesia, were tested for serological and virological markers of both viruses. HBV surface antigen (HBsAg) was detected in 18 patients (11.2%) and in two staff members (5.7%). Anti-HCV was detected in 130 patients (80.7%) but not in any staff members. Occult HBV and HCV infection were detected in 21 (14.7%) and 4 (12.9%) patients, respectively. The overall prevalence rates of HBV and HCV infection among patients were 24.2% and 83.2%, respectively. HCV infection was independently associated with hemodialysis duration and the number of blood transfusions. Phylogenetic analysis revealed that 23 of 39 tested HBV strains (59%) were genotype B, 11 (28.2%) were genotype C, and 5 (12.8%) were genotype A. HCV genotype 1a was dominant (95%) among 100 tested HCV strains. Nosocomial transmission was suspected because the genotype distribution differed from that of the general population in Indonesia, and because the viral genomes of several strains were identical. These findings suggest that HBV and HCV infection is common among hemodialysis patients in Yogyakarta, and probably occurs through nosocomial infection. Implementation of strict infection-control programs is necessary in hemodialysis units in Indonesia.
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Affiliation(s)
- Hanggoro Tri Rinonce
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
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18
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High prevalence of HIV-1 CRF01_AE viruses among female commercial sex workers residing in Surabaya, Indonesia. PLoS One 2013; 8:e82645. [PMID: 24367533 PMCID: PMC3867361 DOI: 10.1371/journal.pone.0082645] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/26/2013] [Indexed: 12/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) cause serious health problems and have an impact on the Indonesian economy. In addition, the rapid epidemic growth of HIV is continuing in Indonesia. Commercial sex plays a significant role in the spread of HIV; therefore, in order to reveal the current HIV prevalence rate among commercial sex workers (CSWs), we conducted an epidemiological study on HIV infection among CSWs residing in Surabaya, the capital of East Java province of Indonesia with large communities of CSWs. Methodology/Principal Findings The prevalence of HIV infection among 200 CSWs was studied. In addition, the subtype of HIV type 1 (HIV-1) and the prevalence of other blood-borne viruses, hepatitis B virus (HBV), hepatitis C virus (HCV) and GB virus C (GBV-C), were studied. The prevalence rates of HIV, hepatitis B core antibody, hepatitis B surface antigen, anti-HCV antibodies and anti-GBV-C antibodies were 11%, 64%, 4%, 0.5% and 0% among CSWs involved in this study, respectively. HIV-1 CRF01_AE viral gene fragments were detected in most HIV-positive samples. In addition, most CSWs showed low awareness of sexually transmitted diseases and had unprotected sex with their clients. Conclusions/Significance The HIV prevalence rate among CSWs was significantly higher than that among the general population in Indonesia (0.2–0.4%). In addition, CSWs were at a high risk of exposure to HBV, although chronic HBV infection was less frequently established. Our results suggest the necessity of efficient prevention programs for HIV and other blood-borne viral infections among CSWs in Surabaya, Indonesia.
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19
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Utsumi T, Yano Y, Lusida MI, Nasronudin, Amin M, Juniastuti, Soetjipto, Hotta H, Hayashi Y. Detection of highly prevalent hepatitis B virus co-infection with HIV in Indonesia. Hepatol Res 2013; 43:1032-9. [PMID: 23336705 DOI: 10.1111/hepr.12053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 10/18/2012] [Accepted: 12/20/2012] [Indexed: 12/15/2022]
Abstract
AIM The prevalence of hepatitis B virus (HBV) co-infection with HIV is increasing worldwide because of shared transmission routes. This study aimed to assess the prevalence of HBV and HIV co-infection in Indonesia, and its molecular and clinical characteristics. METHODS A total of 118 serum samples from HIV-infected patients (age 33.3 ± 8.9 years, 99 male, 19 female) collected in 2009 were serologically examined. HBV DNA was assessed by polymerase chain reaction (PCR) analysis targeting the S region. RESULTS Overall, 15.3% (18/118) of the patients were hepatitis B surface antigen (HBsAg) positive, whereas 27.1% (32/118) were HBsAg negative but HBV DNA positive, and were considered to have occult HBV infection. HBsAg antibodies and/or HBV core antibodies were detected in 45.6% (31/68) of HBV DNA negative patients. CONCLUSION HBV co-infection, including occult HBV infection, was common in Indonesian HIV patients. Hepatic damage by the interaction of host immunity and HBV is still a remaining issue in these immunosuppressive patients, and further study will be needed.
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Affiliation(s)
- Takako Utsumi
- Indonesia-Japan Collaborative Research Center for Emerging and Re-emerging Infectious Diseases, Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia; Center for Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
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20
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Jutavijittum P, Andernach IE, Yousukh A, Samountry B, Samountry K, Thammavong T, Keokhamphue J, Toriyama K, Muller CP. Occult hepatitis B infections among blood donors in Lao PDR. Vox Sang 2013; 106:31-7. [PMID: 23931585 DOI: 10.1111/vox.12073] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES In Lao People's Democratic Republic, hepatitis B virus is highly endemic. However, blood donations are only screened for HBsAg, leaving a risk of transmission by HBsAg-negative occult infected donors. Here, we characterized first-time blood donors to assess prevalence of hepatitis B virus infections and occult infected donors. MATERIALS AND METHODS Sera were screened for HBsAg, HBeAg and anti-HBs, anti-HBc and anti-HBe antibodies. Occult HBV infections (OBIs) were assessed in HBsAg-negative sera by PCR, and sera of HBsAg positive and occult infected donors were phylogenetically characterized. RESULTS 9·6% of the donors were HBsAg positive, and 45.5% were positive for at least one of the hepatitis B virus serum markers. More than 40% HBsAg carriers were HBeAg positive, with HBeAg seroconversion occurring around 30 years of age. Furthermore, 10·9% of HBsAg-negative, anti-HBc and/or anti-HBs-positive donors were occult infected with hepatitis B virus. Thus, at least 3·9% of blood donations would potentially be unsafe, but hepatitis B virus DNA copy numbers greatly varied between donors. CONCLUSION In Lao People's Democratic Republic, a sizable proportion of HBsAg-negative and anti-HBc antibody-positive blood donations are potentially DNA positive and infective for hepatitis B.
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Affiliation(s)
- P Jutavijittum
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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21
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Turyadi, Thedja MD, Ie SI, Harahap AR, El-Khobar KE, Roni M, Muljono DH. HBsAg, HBeAg and HBV DNA level changes and precore/basal core promoter mutations in the natural history of chronic hepatitis B in Indonesian patients. Hepatol Int 2013. [DOI: 10.1007/s12072-013-9438-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Khamduang W, Ngo-Giang-Huong N, Gaudy-Graffin C, Jourdain G, Suwankornsakul W, Jarupanich T, Chalermpolprapa V, Nanta S, Puarattana-Aroonkorn N, Tonmat S, Lallemant M, Goudeau A, Sirirungsi W. Prevalence, risk factors, and impact of isolated antibody to hepatitis B core antigen and occult hepatitis B virus infection in HIV-1-infected pregnant women. Clin Infect Dis 2013; 56:1704-12. [PMID: 23487379 DOI: 10.1093/cid/cit166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prevalence and risk factors for isolated antibody to hepatitis B core antigen (anti-HBc) and occult hepatitis B virus (HBV) infection are not well known in human immunodeficiency virus type 1 (HIV-1)-infected pregnant women. It is unclear if women with occult infections are at risk of transmitting HBV to their infants. METHODS HIV-1-infected and HBV surface antigen (HBsAg)-negative pregnant women were tested for antibody to HBsAg (anti-HBs) and anti-HBc using enzyme immunoassay. Women with isolated anti-HBc were assessed for occult HBV infection, defined as HBV DNA levels >15 IU/mL, using the Abbott RealTime HBV DNA assay. Infants born to women with isolated anti-HBc and detectable HBV DNA were tested at 4 months of age for HBV DNA. Logistic regression analysis was used to identify factors associated with isolated anti-HBc and occult HBV infection. RESULTS Among 1812 HIV-infected pregnant women, 1682 were HBsAg negative. Fourteen percent (95% confidence interval [CI], 12%-15%) of HBsAg-negative women had an isolated anti-HBc that was independently associated with low CD4 count, age >35 years, birth in northern Thailand, and positive anti-hepatitis C virus serology. Occult HBV infection was identified in 24% (95% CI, 18%-30%) of women with isolated anti-HBc, representing 2.6% (95% CI, 1.9%-3.5%) of HIV-1-infected pregnant women, and was inversely associated with HIV RNA levels. None of the women with isolated anti-HBc and occult HBV infection transmitted HBV to their infants. CONCLUSIONS HIV-1-infected pregnant women with isolated anti-HBc and occult HBV infection have very low HBV DNA levels and are thus at very low risk to transmit HBV to their infants.
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Affiliation(s)
- Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai. Thailand
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23
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Allain JP, Candotti D. Hepatitis B virus in transfusion medicine: still a problem? Biologicals 2012; 40:180-6. [PMID: 22305086 DOI: 10.1016/j.biologicals.2011.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 12/25/2022] Open
Abstract
Hepatitis B virus (HBV) has probably evolved with humans for nearly 35,000 years. HBV diversified into 9 genotypes (A-I) presenting specific features directing epidemiology, clinical expression and testing. Genotypes E and C are more infectious and carry higher risk of chronicity and cancer. HBsAg blood screening implemented 40 years ago enormously decreased the risk of transfusion transmission but the remaining risk requires extremely sensitive nucleic acid testing (NAT) to be removed. Limitations of the host immune system, the impact of immunodeficiency and the mechanisms utilised for viral persistence were recently identified. HBV replication produces excess HBsAg and infectious and defective viral particles but screening assays for HBsAg or viral particles alone do not allow fully efficient detection, making necessary screening for both. The host immune system fails to completely control the virus that escapes and persists unrecognized at very low levels or as immuno-selected variants. Variants may not be identified by assays, explaining false negative results. Specific mutations may affect post-transcriptional mechanisms including HBV RNA splicing. Asymptomatic HBV infected blood donors are at risk of long-term complications through mechanisms to be understood for appropriate counselling. Infectivity of occult HBV infection (OBI) by transfusion appears low, anti-HBc (anti-core antigen) only being more infectious than anti-HBs (anti-S protein) positive units.
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24
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Ie SI, Thedja MD, Roni M, Muljono DH. Prediction of conformational changes by single mutation in the hepatitis B virus surface antigen (HBsAg) identified in HBsAg-negative blood donors. Virol J 2010; 7:326. [PMID: 21087462 PMCID: PMC2998485 DOI: 10.1186/1743-422x-7-326] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/18/2010] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Selection of hepatitis B virus (HBV) by host immunity has been suggested to give rise to variants with amino acid substitutions at or around the 'a' determinant of the surface antigen (HBsAg), the main target of antibody neutralization and diagnostic assays. However, there have never been successful attempts to provide evidence for this hypothesis, partly because the 3 D structure of HBsAg molecules has not been determined. Tertiary structure prediction of HBsAg solely from its primary amino acid sequence may reveal the molecular energetic of the mutated proteins. We carried out this preliminary study to analyze the predicted HBsAg conformation changes of HBV variants isolated from Indonesian blood donors undetectable by HBsAg assays and its significance, compared to other previously-reported variants that were associated with diagnostic failure. RESULTS Three HBV variants (T123A, M133L and T143M) and a wild type sequence were analyzed together with frequently emerged variants T123N, M133I, M133T, M133V, and T143L. Based on the Jameson-Wolf algorithm for calculating antigenic index, the first two amino acid substitutions resulted in slight changes in the antigenicity of the 'a' determinant, while all four of the comparative variants showed relatively more significant changes. In the pattern T143M, changes in antigenic index were more significant, both in its coverage and magnitude, even when compared to variant T143L. These data were also partially supported by the tertiary structure prediction, in which the pattern T143M showed larger shift in the HBsAg second loop structure compared to the others. CONCLUSIONS Single amino acid substitutions within or near the 'a' determinant of HBsAg may alter antigenicity properties of variant HBsAg, which can be shown by both its antigenic index and predicted 3 D conformation. Findings in this study emphasize the significance of variant T143M, the prevalent isolate with highest degree of antigenicity changes found in Indonesian blood donors. This highlights the importance of evaluating the effects of protein structure alterations on the sensitivity of screening methods being used in detection of ongoing HBV infection, as well as the use of vaccines and immunoglobulin therapy in contributing to the selection of HBV variants.
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Affiliation(s)
- Susan I Ie
- Eijkman Institute for Molecular Biology, Jl. Diponegoro 69, Jakarta, Indonesia
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