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

Occult hepatitis B in Iranian blood donors, an overview of the challenges: A narrative review

Background

Occult hepatitis B infection (OBI) is a transfusion-transmitted infection. Although, screening the hepatitis B virus among blood donors can play an important role in increasing the health of blood products, OBI screening in blood transfusion centers is still a challenge. This review study aimed to appraise the challenges of OBI screening and its associated do's and don'ts in blood transfusion centers.

Methods

In this review study, a search was conducted on the electronic databases of PubMed, Web of Science, Scopus, Ovid, Irandoc, and Magiran from January 1996 to December 2020. Also, cross-sectional studies that determined the prevalence of OBI or anti-HBc were included in the study. In addition, studies with incomplete data on the prevalence of OBI were excluded.

Results

The prevalence of OBI varies among Iranian blood donors. The rates reported by blood transfusion centers of Mashhad, Ahvaz, and Tehran were 0%, and Isfahan, Shiraz, and Kerman were 0.9%, 0.08%, and 2.36%, respectively. In areas with high prevalence of hepatitis B virus, OBI screening only by anti-HBc test led to the exemption of blood donors from donating blood. Avoiding OBI screening also effected the risk of virus transmission to blood recipients. Plasma products had a higher risk (85%) of virus transmission.

Conclusions

Determining an appropriate screening strategy based on prevalence status, the cost-effectiveness of screening tests, and the policies of each blood transfusion center is essential.

Occult Hepatitis B Infection among Hemodialysis in Tabriz, Northwest of Iran: Prevalence and Mutations within the S Region

Regardless of the extensive screening for the detection of hepatitis B surface antigen (HBsAg), hemodialysis (HD) patients are still severely at the risk of occult hepatitis B virus infection (OBI), especially in developing countries. OBI is defined as the presence of HBV DNA with undetectable HBsAg in the liver and/or Serum. This study aims to determine the prevalence of OBI in HD patients in Tabriz Province, northwest of Iran, and inquire about the mutations in the detected HBsAg. In this cross-sectional descriptive study, ELISA method assessed serum and plasma samples of 118 HBsAg-negative patients undergoing HD treatment for HBV serological markers (HBsAg and Anti-HBc). Specific primers by nested polymerase chain reaction have been utilized to examine HBV DNA; also, direct sequencing of surface genes was carried out to characterize the viral genotypes and S gene mutations. Finally, followed by real-time PCR, the quantity of viral load in OBI-positive patients was determined. A total of 118 HD patients were included (63.6% were male and 36.4% female), with an overall mean age of 60.8 ± 12.8 years old. The prevalence of antihepatitis B core antibody (Anti-HBc) in the study population was 26.3% (31/118). Five patients (4.2%) were positive for HBV DNA and labeled OBI-positive; their plasma HBV-DNA load was less than 100 IU/ml. Following the phylogenetic analysis, the samples with OBI roughly belonged to genotype D, subtype ayw2 and only two had mutations within the S ’gene’s major hydrophilic region (MHR), including T123I, C124F, and P127T. This study reports the prevalence of OBI in the HBsAg-negative HD patients being at a rate of 4.2%, which can be a clinically vital consideration in this region. HBV serologic screening approaches need to be renewed to cover nucleic acid testing in the setting of hemodialysis and all the other high-risk groups associated with it (i.e., blood and organ donors).

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

Background

Based on evidence, human immunodeficiency virus (HIV) and hepatitis B virus (HBV) have common transmission routes; co-infection of HBV/HIV can dramatically increase disease progression. The present study aimed to determine the prevalence of overt HBV infection and occult hepatitis B virus infection (OBI) in HIV-positive people.

Methods

In this descriptive study, whole blood samples were collected from 184 HIV-positive subjects referring to the Consultation Center for Behavioral Diseases, Sanandaj, Iran, during 2014 to 2016. ELISA was used for the determination of HBV serologic markers (hepatitis B surface antigen [HBsAg] and antibodies to hepatitis B virus core antigen [anti-HBc]). To evaluate OBI, DNA was extracted only from HBsAg-negative and anti-HBc-positive samples and tested for HBV DNA by real-time PCR. Test results and patients’ data were analyzed by SPSS software.

Results

The mean age of the study population was 39.2 ± 9.4 (SD) years, of whom 140 (76%) were male. Overall, 43 (23.3%) samples were positive for HBsAg (overt HBV infection), and 50 (27.2%) for anti-HBc. Among 31 HBsAg-negative and anti-HBc-positive samples (suspected OBI), one (3.2%) sample was positive for HBV DNA (verified seropositive OBI). HBV infection was higher among males (n = 37; 86.05%), jobless people (n = 23; 53.49%), and those with an injection HIV transmission route (n = 32; 74.43%).

Conclusion

We observed a high prevalence of overt HBV and one OBI among the study population. A serologic marker such as anti-HBc indicates resolved or past HBV infection. Molecular screening for HBV is valuable for the management of HIV-infected people.

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

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