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Pham TTH, Nguyen HP, Luu TN, Le NB, Vo VT, Huynh NT, Phan QH, Le TH. Combined Mueller matrix imaging and artificial intelligence classification framework for Hepatitis B detection. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:075002. [PMID: 36451700 PMCID: PMC9321198 DOI: 10.1117/1.jbo.27.7.075002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/15/2022] [Indexed: 06/02/2023]
Abstract
SIGNIFICANCE The combination of polarized imaging with artificial intelligence (AI) technology has provided a powerful tool for performing an objective and precise diagnosis in medicine. AIM An approach is proposed for the detection of hepatitis B (HB) virus using a combined Mueller matrix imaging technique and deep learning method. APPROACH In the proposed approach, Mueller matrix imaging polarimetry is applied to obtain 4 × 4 Mueller matrix images of 138 HBsAg-containing (positive) serum samples and 136 HBsAg-free (negative) serum samples. The kernel estimation density results show that, of the 16 Mueller matrix elements, elements M 22 and M 33 provide the best discriminatory power between the positive and negative samples. RESULTS As a result, M 22 and M 33 are taken as the inputs to five different deep learning models: Xception, VGG16, VGG19, ResNet 50, and ResNet150. It is shown that the optimal classification accuracy (94.5%) is obtained using the VGG19 model with element M 22 as the input. CONCLUSIONS Overall, the results confirm that the proposed hybrid Mueller matrix imaging and AI framework provides a simple and effective approach for HB virus detection.
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Affiliation(s)
- Thi-Thu-Hien Pham
- International University, School of Biomedical Engineering, HCMC, Ho Chi Minh City, Vietnam
- Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoang-Phuoc Nguyen
- International University, School of Biomedical Engineering, HCMC, Ho Chi Minh City, Vietnam
- Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thanh-Ngan Luu
- International University, School of Biomedical Engineering, HCMC, Ho Chi Minh City, Vietnam
- Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngoc-Bich Le
- International University, School of Biomedical Engineering, HCMC, Ho Chi Minh City, Vietnam
- Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Van-Toi Vo
- International University, School of Biomedical Engineering, HCMC, Ho Chi Minh City, Vietnam
- Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngoc-Trinh Huynh
- University of Medicine and Pharmacy, Department of Pharmacognosy, HCMC, Ho Chi Minh City, Vietnam
| | - Quoc-Hung Phan
- National United University, Department of Mechanical Engineering, Miaoli, Taiwan
| | - Thanh-Hai Le
- Vietnam National University Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Ho Chi Minh City University of Technology (HCMUT), Department of Mechatronics, Ho Chi Minh City, Vietnam
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Pley C, Lourenço J, McNaughton AL, Matthews PC. Spacer Domain in Hepatitis B Virus Polymerase: Plugging a Hole or Performing a Role? J Virol 2022; 96:e0005122. [PMID: 35412348 PMCID: PMC9093120 DOI: 10.1128/jvi.00051-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Hepatitis B virus (HBV) polymerase is divided into terminal protein, spacer, reverse transcriptase, and RNase domains. Spacer has previously been considered dispensable, merely acting as a tether between other domains or providing plasticity to accommodate deletions and mutations. We explore evidence for the role of spacer sequence, structure, and function in HBV evolution and lineage, consider its associations with escape from drugs, vaccines, and immune responses, and review its potential impacts on disease outcomes.
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Affiliation(s)
- Caitlin Pley
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - José Lourenço
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Biosystems and Integrative Sciences Institute, University of Lisbon, Lisbon, Portugal
| | - Anna L. McNaughton
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Nuffield Department of Medicine, University of Oxford Medawar Building, Oxford, United Kingdom
| | - Philippa C. Matthews
- Nuffield Department of Medicine, University of Oxford Medawar Building, Oxford, United Kingdom
- The Francis Crick Institute, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
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Bari RZA, Nawaz H, Majeed MI, Rashid N, Iqbal M, Akram M, Yaqoob N, Yousaf S, Mushtaq A, Almas F, Shahzadi A, Amin I. Surface-enhanced Raman spectroscopic analysis of centrifugally filtered HBV serum samples. Photodiagnosis Photodyn Ther 2022; 38:102808. [PMID: 35301153 DOI: 10.1016/j.pdpdt.2022.102808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Raman spectroscopy is an effective tool for detecting and discriminating centrifugally filtered hepatitis B virus serum and centrifugally filtered control serum. OBJECTIVES The purpose of current study is to separate high molecular weight fractions from low molecular weight fractions present hepatitis B serum to increase the disease diagnostic ability of surface enhanced Raman spectroscopy (SERS). METHODS Clinically diagnosed centrifugally filtered serum samples of hepatitis B patients are subjected for surface enhanced Raman spectroscopy (SERS) in comparison with centrifugally filtered serum samples of healthy individuals by using silver nanoparticles (Ag-NPs) as SERS substrates. Some SERS spectral features are solely observed in centrifugally filtered serum samples of hepatitis B and some SERS spectral are solely observed in centrifugally filtered serum samples of healthy individuals. The diagnostic ability of SERS is further enhanced with different statistical techniques like principal component analysis (PCA), partial least square discriminant analysis (PLS-DA) and partial least square regression analysis (PLSR) have applied. RESULTS The disease biomarkers of hepatitis B are more pronounced after their centrifugation as compared with uncentrifuged form. Statistical tools like principal component analysis (PCA) and partial least square discriminant analysis (PLS-DA) clearly differentiated centrifugally filtered serum samples of hepatitis B from centrifugally filtered serum samples of healthy individuals. Furthermore, partial least square regression analysis (PLSR) has been applied for predicting unknown viral load of centrifugally filtered serum sample of hepatitis B. CONCLUSION SERS technique along with chemometric tools have successfully differentiated centrifugally filtered serum samples of hepatitis B from centrifugally filtered serum samples of healthy individuals. The centrifugal filtration process has increased the differentiation accuracy of PLS-DA in terms of percentage 98% and regression accuracy of PLSR regression analysis in terms of RMSEP (0.30 IU/mL) of this diagnostic method as compared with that of uncentrifuged method.
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Affiliation(s)
- Rana Zaki Abdul Bari
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Haq Nawaz
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan.
| | - Muhammad Irfan Majeed
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan.
| | - Nosheen Rashid
- Department of Chemistry, University of Education, Faisalabad Campus, Faisalabad (38000), Pakistan.
| | - Maham Iqbal
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Maria Akram
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Nimra Yaqoob
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Sadia Yousaf
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Aqsa Mushtaq
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Farakh Almas
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Anam Shahzadi
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad (38000), Pakistan
| | - Imran Amin
- PCR Laboratory, PINUM Hospital, Faisalabad (38000), Pakistan
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Sarowar A, Hirode G, Janssen HLA, Feld JJ. Controversies in Treating Chronic Hepatitis B Virus Infection: Discordant Serologic Results. Clin Liver Dis 2021; 25:805-816. [PMID: 34593154 DOI: 10.1016/j.cld.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite effective vaccines and approved therapeutic agents, hepatitis B virus (HBV) remains a prevalent global health problem. Current guidelines rely on a combination of serologic, virological, and biochemical markers to identify the phase in the natural history of chronic HBV infection. Discordant serologic results can occur, which may lead to misclassification. Commonly encountered results that differ from the typical profiles seen in chronic HBV infection are described. For each scenario, the frequency of occurrence, possible explanations, and recommendations for clinical management are discussed. Recognition of discordant serologic findings is crucial for optimal clinical decision.
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Affiliation(s)
- Arif Sarowar
- Toronto Centre for Liver Disease, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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Yuan H, Chiu PY, Chen CF. Paper-based analytical devices for point-of-care blood tests. BIOMICROFLUIDICS 2021; 15:041303. [PMID: 34326913 PMCID: PMC8310430 DOI: 10.1063/5.0055601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/11/2021] [Indexed: 05/28/2023]
Abstract
Blood can be a window to health, and as a result, is the most intensively studied human biofluid. Blood tests can diagnose diseases, monitor therapeutic drugs, and provide information about the health of an individual. Rapid response blood tests are becoming increasingly essential, especially when subsequent treatment is required. Toward this need, paper-based devices have been excellent tools for performing blood tests due to their ability to conduct rapid and low-cost diagnostics and analyses in a non-laboratory environment. In this Perspective, we review recent advances in paper-based blood tests, particularly focusing on the specific techniques and assays applied. Additionally, we discuss the future of these paper-based devices, such as how the signal intensity can be enhanced and how the in situ synthesis of nanomaterials can be used to improve the sensitivity, functionality, and operational simplicity. With these advances, paper-based devices are becoming increasingly valuable tools for point-of-care blood tests in various practical scenarios.
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Affiliation(s)
- Hao Yuan
- Institute of Applied Mechanics, National Taiwan University, Taipei 106, Taiwan
| | | | - Chien-Fu Chen
- Institute of Applied Mechanics, National Taiwan University, Taipei 106, Taiwan
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6
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Characterization and prediction of viral loads of Hepatitis B serum samples by using surface-enhanced Raman spectroscopy (SERS). Photodiagnosis Photodyn Ther 2021; 35:102386. [PMID: 34116250 DOI: 10.1016/j.pdpdt.2021.102386] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Raman spectroscopy is a promising technique to analyze the body fluids for the purpose of non-invasive disease diagnosis. OBJECTIVES To develop a surface-enhanced Raman spectroscopy (SERS) based method for qualitative and quantitative analysis of hepatitis B viral (HBV) infection from blood serum samples. METHODS Clinically diagnosed hepatitis B virus (HBV) infected serum samples of patients of different levels of viral loads have been subjected for SERS analysis in comparison with the healthy ones by using silver nanoparticles (Ag NPs) based SERS substrates. The SERS measurements were performed on blood serum samples of 11 healthy and 32 clinically diagnosed HBV patients of different viral load levels of different exponentials including (101, 102 called as low level), (103, 104 called as medium level) and (105, 108 called as high level). Furthermore, multivariate data analysis techniques, Principal Component Analysis (PCA) and Partial Least Square Regression (PLSR) were also performed on SERS spectral data. RESULTS The SERS spectral features due to biochemical changes in HBV positive serum samples associated with the increasing viral loads were established which could be employed for HBV diagnostic purpose. PCA was found helpful for the differentiation between SERS spectral data of serum samples of different levels of HBV infection and healthy individuals. PLSR model developed with standard samples of known viral loads for predicting the viral loads of blind/unknown samples with 99% predicted accuracy. CONCLUSION SERS can be employed for qualitative and quantitative analysis of HBV infection from blood serum samples.
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Pisaturo M, Onorato L, Russo A, Coppola N. Prevalence of occult HBV infection in Western countries. J Med Virol 2020; 92:2917-2929. [PMID: 32275083 DOI: 10.1002/jmv.25867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/19/2020] [Indexed: 12/11/2022]
Abstract
Due to a lack of standardized tests, it is difficult to obtain prevalence data and define the real impact of occult HBV infection (OBI) in Western countries. The present review article addresses the prevalence of OBI, defined as presence of hepatitis B virus (HBV) DNA in liver tissue or plasma in HBsAg-negative subjects, in Western countries. This varies in different studies according to the different methodologies used (based on serology vs virology), to the sample analyzed for the diagnosis (liver tissue vs plasma), to the different populations studied, to the different geographical variations in the HBV spread, to the host characteristics (age, gender, risk factors for acquiring HBV infection) and to the presence of other parenteral infections (hepatitis C virus and/or human immunodeficiency virus [HIV] infections). Considering the different liver diseases analyzed, that is in patients with cryptogenic cirrhosis or advanced liver fibrosis, the prevalence of OBI ranges 4% to 38%. Considering the different populations studied, in the case of parenteral blood exposure it is about 45%, in patients with chronic hepatitis C it is estimated at about 52%, in HIV-infected patients it ranges from 0% to 45%, in blood donors from 0% to 22.7% and in hemodialysis patients it ranges from 0% to 54%. In conclusion, OBI is a virological entity to be considered when performing the patient's evaluation for immunosuppressive diseases, liver pathologies, or for blood transfusions. Knowing the prevalence and clinical impact of OBI will allow better patient management.
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Affiliation(s)
- Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine-Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Lorenzo Onorato
- Department of Mental Health and Public Medicine-Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Russo
- Department of Mental Health and Public Medicine-Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine-Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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8
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Rapid screening of hepatitis B using Raman spectroscopy and long short-term memory neural network. Lasers Med Sci 2020; 35:1791-1799. [PMID: 32285292 DOI: 10.1007/s10103-020-03003-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/25/2020] [Indexed: 12/30/2022]
Abstract
This study presents a rapid method to screen hepatitis B patients using serum Raman spectroscopy combined with long short-term memory neural network (LSTM). The serum samples taken from 435 hepatitis B patients and 699 non-hepatitis B people were measured in this experiment. Specific biomolecular changes in three groups of serum samples could be seen in the tentative assignment of Raman peaks. First, principal component analysis (PCA) was used for extracting key features of spectral data, which reduces the dimension of the multidimensional spectrum. Then, LSTM is used to train the spectral data. Finally, the full connection layer completes the classification of HBV. The diagnostic accuracy of the first LSTM model is 97.32%, and the value of AUC is 0.995. The results from the study demonstrate that the combination of serum Raman spectroscopy technique and LSTM provides an effective technical approach to the screening of hepatitis B.
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9
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Khan S, Ullah R, Ashraf R, Khan A, Khan S, Ahmad I. Optical screening of hepatitis-B infected blood sera using optical technique and neural network classifier. Photodiagnosis Photodyn Ther 2019; 27:375-379. [PMID: 31299391 DOI: 10.1016/j.pdpdt.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/27/2019] [Accepted: 07/08/2019] [Indexed: 11/17/2022]
Abstract
In this study we demonstrate the analysis of biochemical changes in the human blood sera infected with Hepatitis B virus (HBV) using Raman spectroscopy. In total, 120 diseased blood samples and 170 healthy blood samples, collected from Pakistan Atomic Energy Commission (PAEC) general hospital, were analyzed. Spectra from each sample of both groups were collected in the spectral range 400-1700 cm-1. Careful spectral analyses demonstrated significant spectral variations (p < 0.0001) in the HBV infected individuals as compared to the normal ones. The spectral variations presumably occur because of the variations in the concentration of important biomolecules. Variations in spectral signatures were further exploited by using a neural network classifier towards machine-assisted classification of the two groups. Evaluation metrics of the classifier showed the diagnostic accuracy of (0.993), sensitivity ( = 0.992), specificity ( = 0.994), positive predictive value ( = 0.992) and negative predictive value ( = 0.994). The observed variations in the molecular concentration may be important markers of the hepatic performance and can be used in the diagnosis and machine-assisted classification of HBV infection.
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Affiliation(s)
- Saranjam Khan
- Department of Physics, Islamia College Peshawar, Khyber Pakhtunkhwa, Pakistan.
| | - Rahat Ullah
- Agri-Biophotonics Division, National Institute for Lasers and Optronics, Nilore, Islamabad 45650, Pakistan
| | - Ruby Ashraf
- Department of Chemistry, COMSATS Institute of Information Technology, Abbottabad, 22060, KPK, Pakistan
| | - Ajmal Khan
- Department of Chemistry, COMSATS Institute of Information Technology, Abbottabad, 22060, KPK, Pakistan
| | - Shamim Khan
- Department of Physics, Islamia College Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), University Campus, Peshawar, Pakistan.
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10
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Khan S, Ullah R, Khan A, Ashraf R, Ali H, Bilal M, Saleem M. Analysis of hepatitis B virus infection in blood sera using Raman spectroscopy and machine learning. Photodiagnosis Photodyn Ther 2018; 23:89-93. [PMID: 29787817 DOI: 10.1016/j.pdpdt.2018.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/15/2018] [Accepted: 05/18/2018] [Indexed: 12/12/2022]
Abstract
This study presents the analysis of hepatitis B virus (HBV) infection in human blood serum using Raman spectroscopy combined with pattern recognition technique. In total, 119 confirmed samples of HBV infected sera, collected from Pakistan Atomic Energy Commission (PAEC) general hospital have been used for the current analysis. The differences between normal and HBV infected samples have been evaluated using support vector machine (SVM) algorithm. SVM model with two different kernels i.e. polynomial function and Gaussian radial basis function (RBF) have been investigated for the classification of normal blood sera from HBV infected sera based on Raman spectral features. Furthermore, the performance of the model with each kernel function has also been analyzed with two different implementations of optimization problem i.e. Quadratic programming and least square. 5-fold cross validation method has been used for the evaluation of the model. In the current study, best classification performance has been achieved for polynomial kernel of order-2. A diagnostic accuracy of about 98% with the precision of 97%, sensitivity of 100% and specificity of 95% has been achieved under these conditions.
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Affiliation(s)
- Saranjam Khan
- Agri-Biophotonics Division, National Institute of Lasers and Optronics (NILOP), Nilore, Islamabad 45650, Pakistan.
| | - Rahat Ullah
- Agri-Biophotonics Division, National Institute of Lasers and Optronics (NILOP), Nilore, Islamabad 45650, Pakistan
| | - Asifullah Khan
- Pattern Recognition Lab, DCIS, Pakistan Institutes of Engineering and Applied Sciences (PIEAS), Nilore, Islamabad 45650, Pakistan
| | - Ruby Ashraf
- Department of Chemistry, COMSATS Institute of Information Technology, Abbottabad, KPK 22060, Pakistan
| | - Hina Ali
- Agri-Biophotonics Division, National Institute of Lasers and Optronics (NILOP), Nilore, Islamabad 45650, Pakistan
| | - Muhammad Bilal
- Agri-Biophotonics Division, National Institute of Lasers and Optronics (NILOP), Nilore, Islamabad 45650, Pakistan
| | - Muhammad Saleem
- Agri-Biophotonics Division, National Institute of Lasers and Optronics (NILOP), Nilore, Islamabad 45650, Pakistan
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11
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Anastasiou OE, Widera M, Korth J, Kefalakes H, Katsounas A, Hilgard G, Gerken G, Canbay A, Ciesek S, Verheyen J. Clinical patterns associated with the concurrent detection of anti-HBs and HBV DNA. J Med Virol 2017; 90:282-290. [PMID: 28892166 DOI: 10.1002/jmv.24942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/28/2017] [Indexed: 01/16/2023]
Abstract
Simultaneous detection of anti-HBs and HBV DNA is a rare serological combination and has been described in acute and chronic HBV infection. To scrutinize viral and clinical patterns associated with concurrent detection of anti-HBs and HBV DNA. Simultaneous detection of anti-HBs and HBV DNA was observed in 64/1444 (4.4%) patients treated for HBV infection at the University Hospital of Essen from 2006 to 2016 (8 with acute, 20 with reactivated, and 36 chronic HBV infection). Clinical data and laboratory parameters were analyzed. Regions of the small hepatitis B surface antigen (SHB) and the reverse transcriptase (RT) were sequenced using next generation sequencing (NGS). Among the 64 patients with detectable HBV DNA and anti-HBs, 17 were HBsAg negative (HBsAg[-]), and two had acute liver failure. Patients with acute HBV infection had fewer genotype specific amino acid substitutions in the SHB region than patients with reactivated HBV infection (4 [4.5] vs 9 [16.25], P = 0.043). However, we could observe a significantly higher number of mutations in the a-determinant region when comparing chronically infected patients to patients with acute infection (0 [1] vs 1 [1], P = 0.044). The ratio of nonsynonymous to synonymous mutations (Ka/Ks) was on average >1 for the SHB region and <1 for the RT region. The Ka/Ks ratio (>1) in the SHB region indicates that anti-HBs might have exerted selection pressure on the HBsAg. In three cases the diagnosis of acute HBV infection would have been at least delayed by only focusing on HBsAg testing.
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Affiliation(s)
- Olympia E Anastasiou
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.,Department of Gastroenterology and Hepatology, University Hospital of Essen, Essen, Germany
| | - Marek Widera
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Johannes Korth
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Helenie Kefalakes
- Department of Gastroenterology and Hepatology, University Hospital of Essen, Essen, Germany.,Immunology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, DHHS, Bethesda, Maryland
| | - Antonios Katsounas
- Department of Gastroenterology and Hepatology, University Hospital of Essen, Essen, Germany
| | - Gudrun Hilgard
- Department of Gastroenterology and Hepatology, University Hospital of Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital of Essen, Essen, Germany
| | - Ali Canbay
- Department of Gastroenterology and Hepatology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Sandra Ciesek
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Jens Verheyen
- Institute of Virology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Beltrán Duran M, Berrío-Pérez M, Bermúdez MI, Cortés A, Molina G, Camacho B, Forero-Matiz SP. Perfiles serológicos de hepatitis B en donantes de sangre con anti-HBc reactivos. Rev Salud Publica (Bogota) 2015. [DOI: 10.15446/rsap.v16n6.28848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p><strong>Objetivo </strong>Determinar los perfiles serológicos para el virus de hepatitis B, en donantes de sangre anti-HBc reactivo y antígeno de superficie no reactivo, provenientes de cuatro ciudades del país<strong></strong></p><p><strong>Métodos</strong> Se realizó un estudio prospectivo transversal, durante un período de 17 meses, aplicando el perfil serológico completo de la hepatitis B, en muestras de donantes con anti-HBc reactivo y antígeno de superficie de hepatitis B no reactivo. Los resultados fueron analizados utilizando Microsoft<sup>®</sup> Excel y Epiinfo V 3.5.1.</p><p><strong>Resultados </strong>Se encontró que el 75 % de los donantes reactivos para anti-HBc en los bancos de sangre, presentaban algún marcador adicional de exposición para el VHB; el 1,3 % de los donantes presentaban marcadores serológicos de infección crónica por hepatitis B y un caso que resultó reactivo solamente para antígeno de superficie de hepatitis B. Se halló perfil de vacunación en el 6,1 % de donantes, que fueron reactivos solamente para anticuerpo contra antígeno de superficie.</p><p><strong>Conclusiones. </strong>Se ratifica la importancia de la tamización de anti-HBc, a los donantes de sangre.</p>
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van de Laar TJ, Marijt-van der Kreek T, Molenaar-de Backer MW, Hogema BM, Zaaijer HL. The yield of universal antibody to hepatitis B core antigen donor screening in the Netherlands, a hepatitis B virus low-endemic country. Transfusion 2014; 55:1206-13. [PMID: 25494685 DOI: 10.1111/trf.12962] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/24/2014] [Accepted: 10/30/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the Netherlands, universal antibody to hepatitis B core antigen (anti-HBc) donor screening was introduced in July 2011 to intercept potentially infectious donations slipping through hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA minipool screening (HBV DNA MP6). STUDY DESIGN AND METHODS The yield and donor loss were evaluated after the first 2 years of universal anti-HBc donor screening. A total of 382,173 donors were tested for anti-HBc and, if positive, for antibody to HBsAg (anti-HBs). Anti-HBc-reactive donors with anti-HBs of less than 200 IU/L were deferred, but repeat donors were allowed retesting after 6 months if anti-HBs was less than 10 IU/mL. Anti-HBc false positivity was estimated using the crude anti-HBc signal, family name-based ethnicity scoring, and donor follow-up. RESULTS Anti-HBc screening identified 13 confirmed or potential HBsAg- and HBV DNA MP6-negative recent HBV infections. In addition, 820 anti-HBc-reactive donors with low anti-HBs titers (<200 IU/mL), potentially harboring occult HBV infection (OBI), were identified and deferred. Overall, 1583 (0.41%) donors were deferred: 1178 (0.31%) during first-time anti-HBc screening, 361 (0.09%) anti-HBc seroconverters, and 44 (0.01%) donors with waning anti-HBs titers. Only 188 of 1583 (12%) deferred donors could be reentered upon retesting. Estimated anti-HBc false positivity was 16%, but varied greatly among anti-HBc-reactive donors with and without anti-HBs (8% vs. 62%). CONCLUSION Anti-HBc testing has improved the safety of the Dutch blood supply but its exact yield remains difficult to determine, due to the complexity of confirming anti-HBc reactivity and OBI. In a low-endemic country, donor loss associated with anti-HBc screening is sustainable, but adds to the already considerable list of donor exclusions.
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Affiliation(s)
- Thijs J van de Laar
- Department of Blood-Borne Infections, Division of Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Department of Virology, Division of Diagnostics, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Tanneke Marijt-van der Kreek
- Unit of Medical Donor Affairs, Division of Blood Bank, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Marijke W Molenaar-de Backer
- Department of Blood-Borne Infections, Division of Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Department of Virology, Division of Diagnostics, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Boris M Hogema
- Department of Blood-Borne Infections, Division of Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Department of Virology, Division of Diagnostics, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Hans L Zaaijer
- Department of Blood-Borne Infections, Division of Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Department of Clinical Virology (CINIMA), Academic Medical Centre/University of Amsterdam, Amsterdam, The Netherlands
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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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15
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Anvari FA, Alavian SM, Norouzi M, Mahabadi M, Jazayeri SM. Prevalence and molecular analysis of occult hepatitis B virus infection isolated in a sample of cryptogenic cirrhosis patients in iran. Oman Med J 2014; 29:92-6. [PMID: 24715933 DOI: 10.5001/omj.2014.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 12/19/2013] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aims of this study are to investigate the prevalence of occult hepatitis B virus infection among patients with cryptogenic cirrhosis and to analyze the relationship between surface protein variability and occult hepatitis B virus infection, which may be related to the pathogenesis of occult hepatitis B virus infection in cryptogenic cirrhosis. Occult hepatitis B virus infection is a well-recognized clinical entity characterized by the detection of hepatitis B virus DNA in serum and/or liver in the absence of detectable hepatitis B virus surface antigen, with or without any serological markers of a past infection. METHODS Sera from patients with cryptogenic chronic liver disease were tested for hepatitis B virus DNA using both real-time and nested PCR. In the detected hepatitis B virus DNA samples, the surface gene was analyzed for mutations. RESULTS Hepatitis B virus DNA was detected in 38% of patients, all of whom had a viral load below 10,000 copies/mL. All hepatitis B virus belonged to genotype D. There were no significant associations between occult hepatitis B virus infection status and age, gender, ALT/AST levels, viral load or serologic markers of previous hepatitis B virus infection. There were 14 mutations found in 5 patients; 6 were in the major hydrophilic region, of which 4 were Y134F assigning for the "a" determinant region. All patients who acquired Y134F contained S207R (within HLA-A2-restricted CTL epitope) as a combination. CONCLUSION Hepatitis B virus surface antigen variants may arise as a result of natural selection to evade the immune surveillance of the infected host, and subsequently may go undetected by conventional hepatitis B virus surface antigen screening tests. Etiological diagnosis of cryptogenic cirrhosis is significantly underestimated with current serology testing methods alone.
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Affiliation(s)
- Fatemeh Akhavan Anvari
- Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, PO Box: 15155-6446, Tehran, Iran. Tel/
| | - Seyed Moayyed Alavian
- Baqiyatallah University of Medical Sciences, Baqiyatallah Research Center for Gastroenterology and Liver Disease, P.O. Box: 15155-6446, Tehran, Iran
| | - Mehdi Norouzi
- Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, PO Box: 15155-6446, Tehran, Iran. Tel/
| | - Mostafa Mahabadi
- Baqiyatallah University of Medical Sciences, Baqiyatallah Research Center for Gastroenterology and Liver Disease, P.O. Box: 15155-6446, Tehran, Iran
| | - Seyed Mohammad Jazayeri
- Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, PO Box: 15155-6446, Tehran, Iran. Tel/
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16
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Masarone M, De Renzo A, La Mura V, Sasso FC, Romano M, Signoriello G, Rosato V, Perna F, Pane F, Persico M. Management of the HBV reactivation in isolated HBcAb positive patients affected with Non Hodgkin Lymphoma. BMC Gastroenterol 2014; 14:31. [PMID: 24533834 PMCID: PMC3938973 DOI: 10.1186/1471-230x-14-31] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/13/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Occult HBV infection (OBI) is defined by the persistence of HBV in the liver without serum HBsAg and HBVDNA. It represents a life-threatening event during immunosuppressive chemotherapies. An OBI occurs in approximately 18% of HBcAb + patients. International guidelines suggest surveillance for HBV markers in immunosuppressed patients. In Non-Hodgkin Lymphoma (NHL), the prevalence of OBI reactivation remains to be established. METHODS In order to determine the prevalence of occult HBV reactivation in a large cohort of patients during chemotherapy for NHL, we analysed 498 NHL patients in a centre of Southern Italy. We evaluated HBV markers, NHL type, treatment type and occurrence of HBV reactivation. RESULTS Forty % of patients were treated with monoclonal antibodies and 60.3% without. Ninety-six patients were HBcAb+, HBsAg-. HBV reactivation occurred in ten subjects of this subgroup. All of them were successfully treated with Lamivudine. None of the patients experienced liver-related death. The prevalence of OBI reactivation was of 10.42% in HBcAb + HBsAb- patients. This event occurred in 50% of patients treated with mild immunosuppressive therapies. Each reactivation was treated with Lamivudine. DISCUSSION This report suggests that a strict surveillance is important and cost-effective in HBcAb + HBsAg- NHL patients treated with mild immunosuppressive therapies, in order to detect an occult HBV reactivation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, University of Salerno, Via Allende, Baronissi (Salerno) CAP: 84081, Italy.
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Abd El Kader Mahmoud O, Abd El Rahim Ghazal A, El Sayed Metwally D, Elnour AM, Yousif GEA. Detection of occult hepatitis B virus infection among blood donors in Sudan. J Egypt Public Health Assoc 2013; 88:14-18. [PMID: 23528527 DOI: 10.1097/01.epx.0000427065.73965.c8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Sudan is classified among countries with a high hepatitis B surface antigen (HBsAg) endemicity of more than 8%. Cross-sectional studies have showed a marked increase in the prevalence of occult hepatitis B infection (OBI) in patients with cirrhosis or hepatocellular carcinoma. In terms of OBI infectivity by transfusion, it is largely unknown whether residual risk estimates translate into true rates of infection. AIM The current study aimed to determine the frequency of OBI among blood donors in Sudan. MATERIALS AND METHODS This study was carried out during the period between 2011 and 2012. It included 100 HBsAg-negative blood donors who attended the Central Blood Bank in Sudan. Sera collected from all donors were tested for HBsAg, antibodies against hepatitis B core antigen (anti-HBc), antibodies against hepatitis Be antigen (anti-HBe), and antibodies against hepatitis B surface antigen (anti-HBs) by enzyme-linked immunosorbant assay. Anti-HBc-positive patients were tested for hepatitis B virus (HBV)-DNA. RESULTS The anti-HBc was detected in 42% of the blood donors, among whom 90.5% were positive for HBV-DNA. Two main profiles have been detected, namely, the presence of the three genes (S, C, and X genes) together in 35.7% of the blood donors or the presence of the X gene in addition to the core gene. CONCLUSION AND RECOMMENDATIONS With the use of HBsAg as the sole detection marker for HBV, there is a danger of HBV transmission through blood transfusion. Anti-HBc testing should be added to the routine blood donor screening test if occult hepatitis B is to be diagnosed.
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Affiliation(s)
- Ola Abd El Kader Mahmoud
- aDepartment of Microbiology Medical Research Institute, University of Alexandria, Alexandria, Egypt bDepartment of Haematology, Faculty of Medicine, University of Elimam Elmahdi, Kosti cMedical Laboratory Science, University of Khartoum, Khartoum, Sudan
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18
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Osiowy C, Simons BC, Rempel JD. Distribution of viral hepatitis in indigenous populations of North America and the circumpolar Arctic. Antivir Ther 2013; 18:467-73. [DOI: 10.3851/imp2597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2012] [Indexed: 10/26/2022]
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19
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Occult Hepatitis B (OBH) in Clinical Settings. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hapatmon.6126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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20
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Alavian SM, Miri SM, Hollinger FB, Jazayeri SM. Occult Hepatitis B (OBH) in Clinical Settings. HEPATITIS MONTHLY 2012; 12:e6126. [PMID: 23087749 PMCID: PMC3475016 DOI: 10.5812/hepatmon.6126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 06/20/2012] [Accepted: 07/08/2012] [Indexed: 12/11/2022]
Abstract
CONTEXT Occult hepatitis B (OHB), or persistent HBV DNA in patients who are hepatitis B surface antigen (HBsAg) negative, is a recently recognized entity. In an attempt to summarize the issues, this review presents an overview of the current proposed hypothesis on the clinical relevance and also updates the knowledge on the classification of OHB in different clinical settings. EVIDENCE ACQUISITION OHB COULD BE FOUND IN DIFFERENT POPULATION AND CLINICAL BACKGROUNDS INCLUDING: viral co-infections (with either human immunodeficiency or hepatitis C viruses), HBV chronic carriers, dialysis patients, transplantation settings and certain clinical situations (named in here: special clinical settings) with no apparent distinguishable clinical parameters. RESULTS The exact magnitude, pathogenesis, and clinical relevance of OHB are unclear. Even the possible role exerted by this cryptic infection on liver disease outcome, and hepatocellular carcinoma development remains unknown. CONCLUSIONS Monitoring of Individuals with positive anti-HBc, mass immunization programs and improvement in diagnostic tools seem to be important to control the probability of transmission of HBV through cryptic HBV infection.
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Affiliation(s)
- Seyed Moayed Alavian
- Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mohammad Miri
- Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | - Seyed Mohammad Jazayeri
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Seyed Mohammad Jazayeri, Department of Virology, School of Public Health, Tehran University of Medical Sciences, P.O. Box: 15155-6446, Tehran, IR Iran.Tel.: +98-2188992660, Fax: +98-2188992660, E-mail:
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Niederhauser C. Reducing the risk of hepatitis B virus transfusion-transmitted infection. J Blood Med 2011; 2:91-102. [PMID: 22287868 PMCID: PMC3262354 DOI: 10.2147/jbm.s12899] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Indexed: 12/28/2022] Open
Abstract
Before 1970, approximately 6% of multi-transfused recipients acquired a transfusion-transmitted Hepatitis B virus (HBV) infection. The safety improvements since then have been tremendous. From a level of a few infections per 1000 donations, the risk today, depending on the screening algorithm and additional measurements performed, has decreased to around 1:500,000 to 1:1,000,000, an improvement greater than 1000-fold compared to 50 years ago. This enormous gain in safety has been achieved through many factors, including development of increasingly more sensitive Hepatitis B antigen (HBsAg) assays; the adoption in some countries of hepatitis B core antibody (anti-HBc) screening; an improved donor selection procedure; HBV vaccination programs; and finally the introduction of HBV nucleic acid testing (NAT). Because there is a tendency in transfusion medicine to add one safety measure on top of another to approach the ultimate goal of zero risks, costs become increasingly a matter of debate. It is obvious that any new measure in addition to existing methods or measures will have very poor cost effectiveness. Therefore each country needs to perform its own calculation based on the country’s own epidemiology, resources, political and public awareness of the risks, in order to choose the correct and most cost-efficient measures. Ideally, each country would make decisions regarding implementation of additional blood safety measures in the context of both the perceived benefit and the allocation of overall health care resources.
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22
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Said ZNA. An overview of occult hepatitis B virus infection. World J Gastroenterol 2011; 17:1927-38. [PMID: 21528070 PMCID: PMC3082745 DOI: 10.3748/wjg.v17.i15.1927] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/18/2011] [Accepted: 01/25/2011] [Indexed: 02/06/2023] Open
Abstract
Occult hepatitis B virus (HBV) infection (OBI), alternatively defined as occult hepatitis B (OHB), is a challenging clinical entity. It is recognized by two main characteristics: absence of HBsAg, and low viral replication. The previous two decades have witnessed a remarkable progress in our understanding of OBI and its clinical implications. Appropriate diagnostic techniques must be adopted. Sensitive HBV DNA amplification assay is the gold standard assay for detection of OBI. Viral as well as host factors are implicated in the pathogenesis of OBI. However, published data reporting the infectivity of OBI by transfusion are limited. Several aspects including OBI transmission, infectivity and its relation to the development of chronic liver diseases and hepatocellular carcinoma have to be resolved. The aim of the present review is to highlight recent data on OBI with a focus on its virological diagnosis and clinical outcome.
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Gutiérrez-García ML, Fernandez-Rodriguez CM, Lledo-Navarro JL, Buhigas-Garcia I. Prevalence of occult hepatitis B virus infection. World J Gastroenterol 2011; 17:1538-42. [PMID: 21472117 PMCID: PMC3070122 DOI: 10.3748/wjg.v17.i12.1538] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/16/2010] [Accepted: 11/23/2010] [Indexed: 02/06/2023] Open
Abstract
Occult hepatitis B virus (HBV) infection (OBI) is characterized by the persistence of HBV DNA in the liver tissue in individuals negative for the HBV surface antigen. The prevalence of OBI is quite variable depending on the level of endemic disease in different parts of the world, the different assays utilized in the studies, and the different populations studied. Many studies have been carried out on OBI prevalence in different areas of the world and categories of individuals. The studies show that OBI prevalence seems to be higher among subjects at high risk for HBV infection and with liver disease than among individuals at low risk of infection and without liver disease.
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Occult hepatitis B: clinical implications and treatment decisions. Dig Dis Sci 2010; 55:3328-35. [PMID: 20927592 PMCID: PMC3001399 DOI: 10.1007/s10620-010-1413-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/26/2010] [Indexed: 01/27/2023]
Abstract
First reported in 1978, occult hepatitis B is a term used to describe the presence of hepatitis B virus (HBV) DNA without hepatitis B surface antigenemia. The prevalence of occult HBV is unclear and depends in part on the sensitivity of the hepatitis B surface antigen (HBsAg) and DNA assays used as well as the prevalence of HBV infection in the study population. The origin of occult HBV also remains in question. Several mechanisms have been hypothesized including mutations in the regulatory regions of the HBV genome, persistence of Ig-bound HBV immune complexes, viral interference, and blockage of free HBsAg secretion. Occult HBV has important clinical implications such as transmission through blood transfusion, reactivation in the setting of immunosuppression, and interference with hepatitis C treatment. To date, there is little data pertaining to the treatment of occult HBV outside of the setting of chemotherapy-induced HBV reactivation.
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25
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Liu Y, Li P, Li C, Zhou J, Wu C, Zhou YH. Detection of hepatitis B virus DNA among accepted blood donors in Nanjing, China. Virol J 2010; 7:193. [PMID: 20718994 PMCID: PMC2931482 DOI: 10.1186/1743-422x-7-193] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 08/19/2010] [Indexed: 12/17/2022] Open
Abstract
Background Posttransfusion hepatitis B virus (HBV) infection still occurs although its incidence has been substantially reduced since the introduction of screening of hepatitis B surface antigen (HBsAg) in blood donors. This study aimed to investigate the occult HBV infection in accepted blood donors in Nanjing, China. Results The lower detection limit of the nested PCR in this study was estimated to be 20 copies/ml HBV DNA. The positive rate of occult HBV infection was 0.13% (5 of 2972) in the accepted blood donors. Sequencing data showed that the amplified HBV sequences were not identical each other and to the known sequences cloned in our laboratory, excluding the false-positive caused by cross-contamination. Phylogenetic analysis showed that the HBV in all five donors was genotype B; a single base deletion was detected in the S region of HBV DNA from one donor, and no mutation was observed in the "a" determinant of HBsAg from four other donors. All five donors were negative for anti-HBs and one was positive for anti-HBc. Conclusions The prevalence of occult HBV infection in the accepted blood donors in Nanjing, China is relatively high. The data would be meaningful in adapting strategy to eliminate posttransfusion HBV infection in China.
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Affiliation(s)
- Yong Liu
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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26
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Molecular characteristics of occult hepatitis B virus from blood donors in southeast China. J Clin Microbiol 2009; 48:357-62. [PMID: 19940057 DOI: 10.1128/jcm.01781-09] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The characteristics of 30 carriers with occult hepatitis B virus (HBV) infection (OBI) were compared with those of 30 individuals diagnosed as being HBV carriers at the time of blood donation, 60 asymptomatic carriers, and 60 chronic hepatitis patients. The prevalence of genotype C was significantly higher in carriers with OBIs than in any other HBsAg-positive (HBsAg(+)) group (P < 0.001). Specific amino acid substitutions in the regions from amino acids 117 to 121 and amino acids 144 to 147 located in the major hydrophilic region of the S gene were associated with carriers with OBIs (P < 0.01 for carriers with OBIs versus HBsAg(+) donors, carriers with OBIs versus HBsAg(+) asymptomatic carriers, and carriers with OBIs versus HBsAg(+) chronic hepatitis patients). G145R was the major variation in the HBV isolates responsible for local occult HBV infections.
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Hu XB, Yue QH, Zhang XQ, Xu XQ, Wen Y, Chen YZ, Cheng XD, Yang L, Mu SJ. Hepatitis B virus genotypes and evolutionary profiles from blood donors from the northwest region of China. Virol J 2009; 6:199. [PMID: 19917138 PMCID: PMC2781008 DOI: 10.1186/1743-422x-6-199] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 11/17/2009] [Indexed: 12/12/2022] Open
Abstract
Hepatitis B virus (HBV) is prevalent in China and screening of blood donors is mandatory. Up to now, ELISA has been universally used by the China blood bank. However, this strategy has sometimes failed due to the high frequency of nucleoside acid mutations. Understanding HBV evolution and strain diversity could help devise a better screening system for blood donors. However, this kind of information in China, especially in the northwest region, is lacking. In the present study, serological markers and the HBV DNA load of 11 samples from blood donor candidates from northwest China were determined. The HBV strains were most clustered into B and C genotypes and could not be clustered into similar types from reference sequences. Subsequent testing showed liver function impairment and increasing virus load in the positive donors. This HBV evolutionary data for China will allow for better ELISA and NAT screening efficiency in the blood bank of China, especially in the northwest region.
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Affiliation(s)
- Xing-Bin Hu
- Department of Blood Transfusion, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, PR China.
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Abstract
Hepatitis B virus (HBV) remains a major risk of transfusion-transmitted infection due to the pre-seroconversion window period (WP), infection with immunovariant viruses, and with occult carriage of HBV infection (OBI). Reduction of HBV residual risk depends upon developing more sensitive HBV surface antigen (HBsAg) tests, adopting anti-HBc screening when appropriate, and implementing HBV nucleic acid testing (NAT), either in minipools or more efficiently in individual samples. HBV NAT combines the ability to significantly reduce the window period and to detect occult HBV carriage substantiating decades of clinical observation that HBsAg-negative/anti-HBc-positive blood could transmit HBV. Clinical observations suggest limited transmission rate of occult HBV compared to WP. Low transmission rate might be related to low viral load observed in OBIs or to the presence of mutants associated with occult carriage. OBIs carrying detectable anti-HBs ( approximately 50%) are essentially not infectious by transfusion. However, recent data suggest that the neutralizing capacity of low anti-HBs may be inefficient when overcome by exposure to high viral load. Anti-HBc blood units without detectable anti-HBs appear moderately infectious except in immunocompromised recipients. Immunodeficient elderly and patients receiving immunosuppressive treatments may be susceptible to infection with lower infectious dose even in the presence of anti-HBs. The immune status of blood recipients should be taken into consideration when investigating "post-transfusion" HBV infection. Pre-transfusion testing and post-transfusion long-term follow-up of recipients, and molecular analysis of the virus infecting both donor and recipient are critical to definitively incriminate transfusion in the transmission of HBV.
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Affiliation(s)
- Daniel Candotti
- National Health Service Blood & Transplant, Cambridge Blood Centre, Long Road, Cambridge CB2 2PT, UK.
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Rossi D, Sala L, Minisini R, Fabris C, Falleti E, Cerri M, Burlone ME, Toniutto P, Gaidano G, Pirisi M. Occult hepatitis B virus infection of peripheral blood mononuclear cells among treatment-naive patients with chronic lymphocytic leukemia. Leuk Lymphoma 2009; 50:604-11. [PMID: 19373659 DOI: 10.1080/10428190902777673] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent guidelines emphasise the risk of hepatitis B virus (HBV) reactivation among patients with hematologic malignancies of B lineage, in which HBV has been recently hypothesised to play a pathogenetic role. We aimed to determine the prevalence of occult HBV infection (OBI) of peripheral blood mononuclear cells, defined as detection of sequences from >or=2 HBV genes in subjects lacking hepatitis B surface antigen, among patients with treatment-naive chronic lymphocytic leukemia (CLL). HBV DNA sequences from four HBV genes (S, X, core and pol) were searched for in archival material obtained at diagnosis (N = 173), and from age and sex-matched controls. OBI was observed in 17/173 (10%) patients and 5/173 (3%) controls (OR = 3.6, 95% CI 1.37-9.79, p = 0.014). OBI was not associated with differences on 5-year survival and biological predictors, but patients with CLL with OBI had significantly lower peripheral blood lymphocyte count. After 8 years of observation without treatment, one OBI positive patient with CLL converted into positive HBsAg serology and developed active hepatitis. In conclusion, OBI is significantly more prevalent among patients with CLL than in age and sex-matched controls, and may contribute to the susceptibility of patients with CLL to HBV reactivation, whether exposed or not to biological agents.
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Affiliation(s)
- Davide Rossi
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont A Avogadro, Novara, Italy
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González R, Torres P, Castro E, Barbolla L, Candotti D, Koppelman M, Zaaijer HL, Lelie N, Allain JP, Echevarría JM. Efficacy of hepatitis B virus (HBV) DNA screening and characterization of acute and occult HBV infections among blood donors from Madrid, Spain. Transfusion 2009; 50:221-30. [PMID: 19682332 DOI: 10.1111/j.1537-2995.2009.02343.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Screening of blood units for hepatitis B virus (HBV) DNA identifies donations collected during the window period (WP) of the acute infection and may improve viral safety of the blood supply. It also leads to the detection of occult hepatitis B infection (OBI). STUDY DESIGN AND METHODS From January 2005 to December 2006, a total of 383,267 blood units were screened for hepatitis B surface antigen (HBsAg) and HBV DNA in two transfusion centers in Madrid, using either individual-donation nucleic acid testing (ID-NAT) or minipool (MP-NAT) of eight donations (MP8). Samples positive for HBV DNA and negative for HBsAg were confirmed by a second molecular test, the viral DNA was quantified, and a genome fragment including the region encoding the major hydrophilic region (MHR) of HBsAg was sequenced. RESULTS The overall yield of HBV DNA-positive, HBsAg-negative units was 1 in 21,282 (18 cases), higher when using ID-NAT than MP8-NAT (1:9862 vs. 1:51,011; p < 0.01). Four donations (1/95,817) were collected during the infectious pre-HBsAg WP, one during an early recovery stage, and the remaining 13 (1/29,482) were OBIs, six of whom had no detectable antibody to HBsAg. Low-level Genotype D HBV DNA was detected in all OBI cases; the frequencies of this genotype and MHR amino acid substitutions were significantly higher than reported from unselected Spanish HBsAg carriers. Donors with OBI had normal aminotransferase levels and were significantly older than donors carrying HBsAg. CONCLUSIONS Blood donors in the WP and with OBI are not uncommon in Madrid and are detected at a higher frequency with ID-NAT than MP-NAT.
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Affiliation(s)
- Rocio González
- Spanish Red Cross Blood Transfusion Center, Madrid, Spain
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Anderson SA, Yang H, Gallagher LM, O'Callaghan S, Forshee RA, Busch MP, McKenna MT, Williams I, Williams A, Kuehnert MJ, Stramer S, Kleinman S, Epstein J, Dayton AI. Quantitative estimate of the risks and benefits of possible alternative blood donor deferral strategies for men who have had sex with men. Transfusion 2009; 49:1102-14. [DOI: 10.1111/j.1537-2995.2009.02124.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Fang Y, Teng X, Xu WZ, Li D, Zhao HW, Fu LJ, Zhang FM, Gu HX. Molecular characterization and functional analysis of occult hepatitis B virus infection in Chinese patients infected with genotype C. J Med Virol 2009; 81:826-35. [PMID: 19319940 DOI: 10.1002/jmv.21463] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Occult HBV infection is defined as the persistence of HBV DNA in individuals negative for HBV surface antigen (HBsAg), and many different mechanisms have been reported in different countries. However, in China, one of the endemic areas for HBV infection, no reports have been published on occult HBV infection. The present study investigated the virological features and the mechanism of occult HBV infection in China. Full-length HBV DNA from eight patients with occult HBV infection (S1-S8) and three HBsAg-positive cases (SWT1-SWT3) was cloned and sequenced. Additionally, four entire linear HBV genomes from occult cases were transfected transiently into HepG2 cells. The sequencing results showed two major mutations in patients with occult HBV infection as follows: deletions in the pre-S1 (S3, S4, and S7) and X (S1, S2, and S5) regions. Such deletions covered the S promoter and the basal core promoter (BCP), and function analysis of these variants also showed a decrease in DNA replication and antigen expression. Two patients with occult infection (S6 and S8) had no mutations capable of interfering with viral replication and gene expression in the major viral population. Thus, the deletions in the S promoter and the BCP regions that disable the regulatory elements may be the reason for the absence of HBsAg, and multiple mechanisms may be responsible for occult HBV infection.
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Affiliation(s)
- Yong Fang
- Department of Microbiology, Harbin Medical University, Harbin, China
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Katsoulidou A, Paraskevis D, Magiorkinis E, Moschidis Z, Haida C, Hatzitheodorou E, Varaklioti A, Karafoulidou A, Hatzitaki M, Kavallierou L, Mouzaki A, Andrioti E, Veneti C, Kaperoni A, Zervou E, Politis C, Hatzakis A. Molecular characterization of occult hepatitis B cases in Greek blood donors. J Med Virol 2009; 81:815-25. [PMID: 19319945 DOI: 10.1002/jmv.21499] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The use of sensitive nucleic acid testing for hepatitis B virus in blood donors revealed a number of HBV DNA(+) cases among HBsAg(-) donors, a status known as occult HBV infection. The purpose of this study was the serological and molecular characterization of occult HBV infection in Greek blood donors. A prospective study was undertaken in order to identify occult HBV infection cases in blood donors. As part of the routine screening of blood donations in Greece, blood units were screened individually by a multiplex HIV-1/HCV/HBV nucleic acid assay. Initially reactive samples were retested with discriminatory assays. HBV DNA(+)/HBsAg(-) samples were tested further for HBV serological markers and HBV DNA was quantified by real-time PCR. Molecular characterization was performed by sequencing the envelope and polymerase genes of HBV. Preliminary screening revealed 21 occult cases with the following patterns: anti-HBc only: 7 donors, anti-HBc/anti-HBs: 7 donors, anti-HBc/anti-HBe: 5 donors, anti-HBc/anti-HBs/anti-HBe: 2 donors. In all cases, the HBV DNA load was <351 IU/ml. Sequencing was successful in 10 donors (classified within genotype D) revealing several amino acid substitutions related to diagnostic escape and antiviral resistance. HBsAg diagnostic failure and low viral replication in occult HBV infection carriers could possibly be attributed to multiple changes in envelope and polymerase regions, respectively.
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Affiliation(s)
- Antigoni Katsoulidou
- Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
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Kao JH. Diagnosis of hepatitis B virus infection through serological and virological markers. Expert Rev Gastroenterol Hepatol 2008; 2:553-62. [PMID: 19072403 DOI: 10.1586/17474124.2.4.553] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) infection is an important health problem and the major cause of chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC) worldwide. The natural history of chronic HBV infection can be divided into four dynamic phases in HBV carriers who acquire the virus early in life. Diagnosis of HBV infection is usually through serological and virological markers. Hepatitis B surface antigen (HBsAg) is the hallmark of HBV infection and is the first serological marker to appear in acute hepatitis B, and persistence of HBsAg for more than 6 months suggests chronic HBV infection. Hepatitis B e antigen (HBeAg) usually indicates active HBV replication and risk of transmission of infection. Recently, occult HBV infection is recognized as the absence of circulating HBsAg in individuals positive for serum or tissue HBV DNA, irrespective of other HBV serological markers. Meanwhile, monitoring the serum HBV DNA level is valuable for assessing liver disease activity, differentiating other etiologies of hepatitis activity in HBV carriers, predicting risk of HCC development or liver-related mortality, deciding to administer antiviral therapy, determination of the response to antiviral treatment, predicting the risk of developing drug resistance, and detecting the emergence of drug-resistant mutants. On the other hand, HBV genotype C, basal core promoter mutant and pre-S deletion mutant are reported to be associated with increased risk of HCC development. The roles of quantitative HBV serology and intrahepatic HBV covalently closed circular (ccc)DNA deserve further studies. In conclusion, it is particularly important for physicians to screen for HBV infection in HBV-endemic areas and to monitor liver disease progression in HBV carriers by using both serological and virological markers, so that effective treatment can be initiated early before the development of advanced liver disease.
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Affiliation(s)
- Jia-Horng Kao
- Hepatitis Research Center, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 10002, Taiwan.
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35
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Hollinger FB. Hepatitis B virus infection and transfusion medicine: science and the occult. Transfusion 2008; 48:1001-26. [PMID: 18454738 DOI: 10.1111/j.1537-2995.2008.01701.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Arabaci F, Oldacay M. Investigation of Mutant Hepatitis B Virus in Core Antibody Seropositive Cases of Blood Donor Population. JOURNAL OF MEDICAL SCIENCES 2008. [DOI: 10.3923/jms.2008.316.320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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