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Background Occult hepatitis B infection (OBI) is considered a risk factor for progression of liver disease in patients with hepatitis B virus (HBV) infection. This disease progression is reported to be more significant in those with concomitant HIV infection. We aimed to determine the prevalence rate of OBI in a sample of HIV-positive patients. Materials and Methods: Sixty-six HIV-infected patients with positive Hepatitis B core antigen (HBcAb) and negative Hepatitis B surface antigen HBsAg were included. HBV DNA was measured by real time polymerase chain reaction PCR method. Those with positive HBV viral load were considered as seropositive OBI. Then, the patients were studied regarding age, gender, intravenous drug use (IVDU), CD4 count, and concomitant infection by hepatitis C virus (HCV), available in their medical records. Results: Seventy-seven patients (38.5%) had positive HBc antibody (HBcAb). Of 66 patients who were positive for both HIV and HBc antibody, eight patients (12.12%) had OBI. About 3.7% in age group younger than 40 years and 5.3% in age group older than 40 years, OBI was detected. Forty-four patients (54.5%) were male. OBI rate was 22.2% in males and zero in females (P< 0.05). In patients who received ART (anti-retroviral therapy) 11.3% and in those who did not receive ART, 12.4% had OBI. In patients with CD4 count of less than 350/mL, 20.1% and in those with CD4 count > 350/mL, 4.1% had OBI. In those who were IV drug user, 17.94% and in those who were not IV drug user, 3.57% gad OBI. Conclusion The prevalence of OBI in the studied sample of HIV-infected patients is considerable. As we did not find any significant association between OBI and studied factors except for gender, we think that screening for OBI would be useful for HIV-infected patients, especially male patients.

We tested the frequency of occult hepatitis B infection (OBI) among Egyptian healthcare workers (HCWs). We tested 132 HCWs for hepatitis B virus (HBV) DNA by nested polymerase chain reaction (PCR), and hepatitis C virus antibody (anti-HCV) by ELISA. HCV RNA was measured by nested PCR in anti-HCV-positive HCWs. HBV-DNA-positive HCWs were subjected to HBV genotyping. We included 132 HCWs who were negative for hepatitis B surface antigen and positive for hepatitis B core antibody (anti-HBc). OBI was detected in 7 male HCWs, and HBV E genotype was detected in 3, HBV D in 2 and HBV D and E in 2. Two OBI-positive HCWs had a history of neonatal hepatitis B vaccination. Anti-HCV seropositivity was detected in 17 HCWs who were positive for anti-HBc; 15 of whom were positive for HCV RNA by nested PCR. HCV infection was confirmed by anti-HCV and HCV RNA in 1 of 7 HCWs with OBI. In conclusion, Egyptian HCWs have a significant rate of OBI and HBV E genotype is prevalent.الإصابة بعدوى التهاب الكبد الوبائي B الخفي بين العاملين في مجال الرعاية الصحية في مصر.ريم المغلوب، أشرف البحراوي، جمال الديداموني، علاء هاشم، محمد حنفي مرسي، أسامة حنطور، عبد اللطيف حنطور، محمد عبد البصير.أجرينا اختباراً لمدى تكرار الإصابة بعدوى فروس التهاب الكبد B الخفي (OBI) ما بن العاملن المصرين في مجال الرعاية الصحية. وأجرينا تحلياً ل 132 عاماً في المجال الصحي للكشف عن ال DNA لفيروس التهاب الكبد B باستخدام ال PCR المزدوج، والكشف عن الأجسام المضادة لفروس التهاب الكبد C باستخدام ال ELISA. وقيس ال (RNA) لفيروس التهاب الكبد C باستخدام ال PCR المزدوج. وتم الكشف عن الإصابة بفروس التهاب الكبد B الخفي في 7 عاملن ذكور من العاملن في مجال الرعاية الصحية، والنوع الجيني E لفيروس التهاب الكبد B في 3 عاملن، والنوع الجيني D في عاملنْ اثنن، والنوع الجيني E و D في عاملنْ اثنن. وتبنّ أن اثنن من العاملن الذين ثبت إصابتهم بفروس التهاب الكبد B الخفي سبق لهم التطعيم ضد التهاب الكبد B المقدّم لحديثي الولادة. وتم الكشف عن إيجابية مصلية للأجسام المضادة لفروس التهاب الكبد C في 17 عاماً من العاملن في المجال الصحي الذين جاءت نتائج تحليلهم إيجابية للأجسام المضادة لفروس التهاب الكبد B ؛ 15 منهم جاءت نتائجهم إيجابية لل RNA لفروس التهاب الكبد C باستخدام ال PCR المزدوج. نخلص من ذلك إلى ارتفاع معدل الإصابة بفروس التهاب الكبد B الخفي بن العاملن في مجال الرعاية الصحية في مر مع انتشار النوع الجيني E من فروس التهاب الكبد B.Hépatite B occulte chez des agents de soins de santé égyptiens.Nous avons étudié la fréquence de l’hépatite B occulte chez des agents de soins de santé égyptiens. Nous avons examiné 132 agents de santé à la recherche d’ADN du virus de l’hépatite B (VHB) au moyen de l’amplification en chaîne par polymérase (PCR) nichée et de l’anticorps du virus de l’hépatite C (anti-VHC) par la méthode ELISA. L’ARN du VHC a été mesurée par PCR nichée chez des agents de santé positifs pour l’anticorps anti-VHC. Les agents de santé positifs pour l’ADN du VHB ont été soumis au génotypage du VHB. Nous avons inclus 132 agents de soins qui étaient négatifs pour l’antigène de surface de l’hépatite B et positifs pour l’anticorps antinucléaire de l’hépatite B (Anti-HBc). Une hépatite B occulte a été détectée chez 7 agents de santé de sexe masculin, et le VHB de génotype E a été détecté chez trois agents, le VHB de génotype D chez 2 agents, et le VHB de génotype D et E chez 2 agents. Deux des agents positifs pour l’hépatite B occulte avaient été vaccinés durant la période néonatale. Une séropositivité anti-VHC a été détectée chez 17 agents de santé qui étaient positifs pour l’anticorps anti-HBc, dont 15 étaient positifs pour l’ARN du VHC par PCR nichée. L’infection à VHC a été confirmée par l’anti-VHC et par l’ARN du VHC chez 1 agent sur 7 atteints d’hépatite B occulte. En conclusion, les agents de santé égyptiens ont un taux d’hépatite B occulte significatif et le génotype E du VHB est prévalent.

Occult hepatitis B infection (OBI) is a cause of concern while screening the blood donors to prevent transfusion-related transmission of infection. This study was conducted to assess the prevalence of OBI using total anti-HBc by ELISA and DNA detection by real time polymerase chain reaction (PCR). The samples included were negative for HBs Ag by ELISA. Out of 1102 samples tested, 156 were positive for total anti-hepatitis B core antigen and 52/156 by real-time PCR. Overall, the prevalence was found to be 4.71% (52/1102). The results indicate that nucleic acid-based testing should be an essential part of screening procedure to prevent missing of OBI.

International audience; BackgroundIn Cameroon, the prevention of hepatitis B virus (HBV) transmission by blood transfusion is still only based on hepatitis B surface antigen (HBsAg) screening. However, occult HBV infection (OBI) characterised by the absence of detectable HBsAg and low level of viral DNA remains a potential threat for blood safety. The prevalence of OBI was investigated in blood donors from Yaoundé to provide evidence-based recommendations to improve HBV blood safety.Material and methodsBlood donations from August 1st, 2016 to March 31st, 2017 were routinely screened for HBV, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) infections (Murex HBsAg Version 3, Murex HIV Ag/Ab Combination, and Murex HCV Ag/Ab Combination [DiaSorin]). Additional HBV investigations were performed, including hepatitis B core antibody ([HBc] Monolisa Anti-HBc PLUS; BIO-RAD) and HBV DNA tested in minipools of two samples using the quantitative Cobas Taqman HBV assay (Roche; LoQ: 6 IU/mL) and HBV DNA genotyping by sequencing.ResultsOf 1,162 donations analysed, 91 (7.8%) were reactive for HBsAg. All of them were also anti-HBc positive. Among the 1,071 HBsAg negative samples, 522 (48.7%) were reactive for anti-HBc. Six (0.56% of all donations) samples fulfilled the consensus definition of OBI and showed low HBV DNA loads (all

Background Transfusion-transmitted hepatitis B virus continues to be a problem despite its significantly reduced prevalence. In this study, in addition to screening for the presence of HBsAg in donors' blood, anti-HBc and anti-HBs markers were investigated using the chemiluminescence immunoassay (CLIA) method, and real-time PCR was used to detect HBV DNA. Methods The study's material involved serum samples of 4,073 blood donors. HBsAg, anti-HBs, anti-HBc tests were undertaken using the CLIA method, and HBV DNA's presence was investigated using the real-time PCR method. Results HBsAg and anti-HBc tests were negative in 3,331 (81.78%) and positive in 37 (0.90%). For the remaining 705 (17.30%), HBsAg was negative and anti-HBc was positive. According to the results of the anti-HBs test for these samples, HBsAg negativity and anti-HBc and anti-HBs positivity were found in 619 samples (15.19%), while 86 samples (2.11%) were negative for HBsAg and anti-HBs but positive for anti-HBc (isolated anti-HBc positivity). ID-HBV DNA real-time PCR tests were performed on 86 samples. None of the samples was positive for HBV DNA. Conclusions Recommended tests for screening occult HBV infection include anti-HBc, anti-HBs, and/or HBV DNA. Anti-HBc screening may result in loss of donors and blood products, particularly in countries with moderate endemicity of HBV, such as Turkey.

International audience

Background and Aims: Occult hepatitis B virus infection (OBI) is known as an important source of hepatitis B virus (HBV) infection. It is categorized as Hepatitis B surface antigen (HBsAg) not being present and low DNA viral load in serum. In this study, an attempt was made to investigate the outbreak of anti-HBc and OBI among the HBsAg-negative donors in Golestan province. Materials and Methods: The present cross-sectional experiment was conducted on 3500 voluntary blood donors in Golestan province to examine the presence of human immunodeficiency viruses Ag-Ab, HBsAg, and hepatitis C virus Ab. Then, samples with negative results for the mentioned tests were screened for total HBc antibody (IgM-IgG) through ELISA technique. Afterward, HBV-DNA extraction and R-T PCR assay were conducted for all HBsAg negative samples by using Real ART HBV LC PCR kit on a Light Cycler instrument. Results: The study participants included 3255 (93%) male and 245 (7%) female. In general, 385 (11%) out of 3500 samples were anti-HBc positive. HBV-DNA results for every sample with either positive or negative anti-HBc were found to be negative. Conclusions: As the area under study has a high rate of anti-HBc outbreak (11%) without the presence of HBV-DNA, anti-HBc screening can cause blood donor deferrals and limit blood supply; therefore, the HBsAg test with high analytical sensitivity is recommended for HBV screening in this area. Regarding the cost analyses and also the status of HBV endemicity, HBsAg test along with ID-NAT is preferable, if possible, for improving blood safety.

Aim: The aims of this study were to find out the prevalence of occult hepatitis B infection (OBI) in HIV-1 patients, as well as to analyze the mutational patterns of OBI-positive individuals. Materials & methods: 172 HBsAg-negative, HIV-1-positive patients were selected according to data extracted from questionnaires. HBV serologic and molecular assays were performed. An extensive mutational analysis was applied using direct sequencing on HBsAg. Results: Thirty-one samples (18%) were OBI positive. Among 24 available OBI-positive samples, 17 (71%) contained at least one mutation only within ‘a’ determinant region of HBsAg. A stretch of mutations was found between amino acid positions 121 and 136. The physicochemical properties of individual amino acid substitutions and their potential impacts on 3D structure of ‘a’ determinant mutants were also determined. Conclusion: HBV serologic assays are not reliable markers to exclude occult HBV infection in HIV-positive patients.

Occult hepatitis B infection (OBI) is the presence of hepatitis B virus (HBV) DNA in the liver and/or serum (< 200 IU/mL) in HBsAg-negative patients with or without serologic markers of previous viral exposure. The clinical significance of OBI is of concern in post-transfusional hepatitis B infection, hepatitis B reactivation, chronic liver disease and hepatocellular carcinoma (HCC). The diagnosis of OBI relays on the use of highly sensitive and specific laboratory techniques. Herein, comments derived from a study analyzing the frequency and characteristics of OBI in HCC Japanese patients are stated. While OBI and other causes of HCC have been highly studied in Asia and Europe, research in Latin America in these topics is limited. Several findings such as population risk groups with high prevalence of overt and OBI infection, HBV genotype F in Argentinean HCC patients, and the clinical impact of the foreign A-D genotypes suggest the need of further investigation. Additionally, alcoholism, obesity, NASH and type 2 diabetes may override the presence of OBI. Therefore, OBI diagnosis is essential. It is known that anti-HBc alone is a predictive signal of potential OBI and given the fluctuations of the HBV infection markers, testing for HBsAg and anti-HBc at baseline and follow-up is recommended. In conclusion, OBI and other causes involved in the epidemiology of HCC in Latin America are unexplored risk factors. Genome-based research is required to decipher the role of gene-environmental interactions associated with chronic liver disease. Novel algorithms to detect OBI supported by basic/applied/clinical research are also needed.

Objectives: Health care workers, including dentists, are at the front line for acquiring blood-borne virus infections. This study aimed to investigate the prevalence of hepatitis B, hepatitis C and human immunodeficiency viruses among Iranian dentists. Material and Methods: The survey included 1628 dental health care workers who attended the 51st annual Congress of the Iranian Dental Association. Data on the risk of blood-borne virus transmission during health care and infection control practices were gathered from self-administered questionnaires. Sera were screened serologically by enzyme-linked immunosorbent assay (ELISA). The positive samples were examined by polymerase chain reaction (PRC) followed by direct sequencing. Results: Six (0.36%) and 81 (5.0%) were positive for hepatitis B surface antigen (HBsAg) and (anti-hepatitis B virus core antigen (anti-HBc), respectively. Only 1 (0.061%) was positive for anti-hepatitis C virus (anti-HCV). No case was positive for anti-human immunodeficiency virus (anti-HIV). One case was diagnosed as being occult hepatitis B virus (HBV) infection. One thousand five hundred thirty-five (94.3%) of participants had received at least 1 dose of HBV vaccine. One thousand three hundred fifty-nine (88.5%) contained hepatitis B surface antibody (anti-HBs) > 10 IU/ml, of whom 55 (4.0%) were anti-HBc positive, suggesting that they had been infected with HBV in the past. Anti-HBc positive cases had past histories of hepatitis, either their own or their spouses’. Individuals with inadequate anti-HBs levels (< 10 IU/ml) were significantly more prevalent among anti-HBc positive cases (p < 0.001). Conclusions: The prevalence of blood-borne viruses among dental HCWs found in this study was lower than past reports from Iranian dentists and general population. The implementation of HBV vaccination together with improvement in infection control procedures has reduced the potential for risk infection among Iranian dentists.

Aims: To investigate the influence of IL28B polymorphism in occult hepatitis B infection (OBI) and whether IL28B genetic variants are associated with hepatitis B virus (HBV)-specific T-cell responses. Patients and Methods: The rs12979860 IL28B genotype was determined in 34 OBI blood donors, 22 spontaneous HBV resolvers, 36 inactive HBV carriers and 25 seronegative donors. T-cell responses to HBV recombinant proteins were assessed by interferon-γ enzyme-linked immunospot assay. Results: The frequency of the IL28B CC genotype among OBI patients was similar to that of inactive carriers [41 vs. 39%, respectively, p = 0.961; odds ratio (OR) = 1.10; 95% confidence interval (CI) = 0.42-2.86; p = 0.845]. The IL28B CC genotype was found more frequently in spontaneous resolvers, although the differences were not significant (45 vs. 39%, spontaneous resolvers and inactive carriers, respectively; p = 0.828; OR = 1.31; 95% CI = 0.45-3.83; p = 0.622). HBV-specific T-cell responses were detected in OBIs, and significantly stronger T-cell responses towards hepatitis B envelope antigen were observed in those with the IL28B CC genotype. In spontaneous resolvers and inactive carriers, IL28B CC did not correlate with the magnitude of T-cell responses. Conclusions: In OBI donors, IL28B CC correlates with the intensity of HBV-specific T-cell responses. In this study, IL28B CC is not statistically associated with OBI or with HBV clearance, but a larger number of cases is needed before completely ruling out its role in HBV infection.

BACKGROUND Many studies have identified mutations in the hepatitis B surface antigen (HBsAg) as important factors limiting the ability of commercial serological assays to detect this viral antigen. However, an association between mutations in the HBsAg gene and the occurrence of occult HBV infection (OBI) in patients has not been established. OBJECTIVES To detect hepatitis B virus (HBV) DNA in patients with anti-HBc as a unique serological marker, a previously published, cost-effective TaqMan-based real-time polymerase chain reaction (PCR) test with minor groove binding probes was adapted for use in this study. The current study also aimed to investigate HBsAg mutations and genotypes of HBV in OBI at the Viral Hepatitis Ambulatory Clinic in Rio de Janeiro to determine any possible association. METHODS Intra-assay and inter-assay reproducibility were determined, and the mean coefficient of variation values obtained were 2.07 and 3.5, respectively. Probit analysis indicated that the 95% detection level was 25 IU/mL. The prevalence of OBI was investigated in 35 serum samples with an ‘anti-HBc alone’ profile from individuals who attended our clinic between 2011 and 2013. FINDINGS HBV DNA was detected in only one sample, resulting in an OBI rate of 2.9%. Nucleotide sequencing of the pre-S/S region was performed to genotype and analyse mutations within the HBsAg gene of this HBV DNA. The HBV in the OBI case was classified as sub-genotype A1, and a sequence analysis of the small S gene revealed 12 mutations in the major hydrophilic region compared to the consensus A1 sequence. Most of these mutations occurred in amino acid residues that have been reported as clinically relevant because they have been implicated in vaccine escape and/or inability to detect HBsAg by commercial serological assays. MAIN CONCLUSIONS Our study suggests the importance of specific HBsAg mutations, different from those in D, B, and C genotypes, in sub-genotype A1 HBV associated with OBI.

Studies on the prevalence of infection with hepatitis B virus (HBV) among children are scarce in Latin American countries, especially in Mexico. This study was aimed to investigate the prevalence of HBV infection, occult hepatitis B infection (OBI) and HBV genotypes among children with clinical hepatitis. In total, 215 children with clinical hepatitis were evaluated for HBV infection. HBV serological markers and HBV DNA were analysed. OBI diagnosis and HBV genotyping was performed. HBV infection was found in 11.2% of children with clinical hepatitis. Among these HBV DNA positive-infected children, OBI was identified in 87.5% (n = 21/24) of the cases and 12.5% (n = 3/24) were positive for both HBV DNA and hepatitis B surface antigen. OBI was more frequent among children who had not been vaccinated against hepatitis B (p < 0.05) than in those who had been vaccinated. HBV genotype H was prevalent in 71% of the children followed by genotype G (8%) and genotype A (4%). In conclusion, OBI is common among Mexican children with clinical hepatitis and is associated with HBV genotype H. The results show the importance of the molecular diagnosis of HBV infection in Mexican paediatric patients with clinical hepatitis and emphasise the necessity of reinforcing hepatitis B vaccination in children.

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.

Occult hepatitis B infection (OBI) is defined as long-lasting persistence of hepatitis B virus (HBV) DNA in the liver of patients with hepatitis B surface antigen (HBsAg)-negative status, with or without serological markers of previous exposure (antibodies to HBsAg and/or to hepatitis B core antigen). Over the past two decades, significant progress has been made in understanding OBI and its clinical implications. OBI as a cause of chronic liver disease in patients with HBsAg-negative status is becoming an important disease entity. In conditions of immunocompetence, OBI is inoffensive in itself and detection of HBV DNA in the liver does not always indicate active hepatitis. However, when other factors that cause liver damage, such as hepatitis C virus infection, obesity and alcohol abuse are present, the minimal lesions produced by the immunological response to OBI might worsen the clinical course of the underlying liver disease. Several lines of evidence suggest that OBI is associated with progression of liver fibrosis and the development of hepatocellular carcinoma in patients with chronic liver disease. The major interest in OBI is primarily associated with the growing, widely discussed evidence of its clinical impact. The aim of this review is to highlight recent data for OBI, with a major focus on disease progression or carcinogenesis in patients with chronic liver disease.

Purpose Occult hepatitis B infection (OBI) among HIV positive patients varies widely in different geographic regions. We undertook a study to determine the prevalence of occult hepatitis B infection among HIV infected individuals visiting a health facility in South West Cameroon and characterized occult HBV strains based on sequence analyses. Methods Plasma samples (n = 337), which previously tested negative for hepatitis B surface antigen (HBsAg), were screened for antibodies against hepatitis B core (anti-HBc) and surface (anti-HBs) antigens followed by DNA extraction. A 366 bp region covering the overlapping surface/polymerase gene of HBV was then amplified in a nested PCR and the amplicons sequenced using Sanger sequencing. The resulting sequences were then analyzed for genotypes and for escape and drug resistance mutations. Results Twenty samples were HBV DNA positive and were classified as OBI giving a prevalence of 5.9%. Out of these, 9 (45%) were anti-HBs positive, while 10 (52.6%) were anti-HBc positive. Additionally, 2 had dual anti-HBs and anti-HBc reactivity, while 6 had no detectable HBV antibodies. Out of the ten samples that were successfully sequenced, nine were classified as genotype E and one as genotype A. Three sequences possessed mutations associated with lamivudine resistance. We detected a number of mutations within the major hydrophilic region of the surface gene where most immune escape mutations occur. Conclusions Findings from this study show the presence of hepatitis B in patients without any of the HBV serological markers. Further prospective studies are required to determine the risk factors and markers of OBI. Electronic supplementary material The online version of this article (doi:10.1186/s12981-017-0136-0) contains supplementary material, which is available to authorized users.

Background The low, fluctuating levels of DNA characteristic of occult hepatitis B infection make its detection by nucleic acid testing (NAT) a challenge. Methods Four year’s routine use of the Ultrio and Ultrio Plus assays in blood donations in New Zealand was analysed. Results 0·09% of donations tested with Ultrio and Ultrio Plus assays showed reactivity in the multiplex assay, but non-reactivity in all three discriminatory assays and relevant mandatory serological assays (anti-HIV, anti-HCV, HBsAg). These donations were more likely to be anti-HBc reactive (Ultrio, 13%; Ultrio Plus, 57%; random donors, 6·8%). Thirty-four per cent of these anti-HBc-reactive donations were also reactive in either an alternate NAT assay or on repeat multiplex testing. Thirteen per cent of the donors of the discriminatory-negative, anti-HBc-reactive donations who had given other Ultrio- or Ultrio Plus-tested donations had at least one other multiplex reactive donation. Conclusion These findings suggest that their HBV DNA levels are around the assay’s limit of detection, that false reactivity cannot be presumed when a donor fails to discriminate and that caution should be applied when deciding whether to continue accepting donations from such donors.

Hepatitis B is one of the most frequently occurring posttransfusion infections. Occult hepatitis B (OB) is a form of hepatitis B in which, despite the presence of hepatitis B virus (HBV) DNA in the serum and hepatocytes of a carrier, hepatitis B surface antigen is absent. In addition to the risk of transfusion of infection, OB can lead to cirrhosis, hepatic cancer, and reactivation of the viral duplication process in the carrier. The mechanisms responsible for progression of OB are yet to be clarified; however, some investigators have suggested that genetic and immunologic variables may play a significant role in the resistance of some individuals and sensitivity of other patients. This review addresses the current information regarding immunologic status of OB-infected patients.

Background/Aim: Occult hepatitis B infection (OBI) is identified as a form of hepatitis in which despite the absence of detectable HBsAg, HBV-DNA is observed in peripheral blood of patients. The main aim of this study has been to investigate the association between polymorphisms in +874 of IFN-γ and +1188 of IL-12 with their serum level in patients suffering from OBI. Materials and Methods: In this experimental study, plasma samples of 3700 blood donors were tested for the presence of hepatitis B surface antigen (HBsAg) and anti-HBc by ELISA. The HBsAg - /anti-HBc + samples were selected and screened for HBV-DNA by PCR. HBV-DNA positive samples were assigned as OBI cases and ARMS-PCR techniques were performed to examine the two known polymorphisms within IL-12 and IFN-γ. In addition, the serum levels of IL-12 and IFN-γ were also determined by ELISA. Results: Results of this study demonstrated that, 352 (9.5%) out of 3700 blood samples were HBsAg - /anti-HBc + and HBV-DNA was detected in 57/352 (16.1%) of HBsAg - /anti-HBc + samples. Our results showed that groups showed significant difference in CC allele of +1188 region of IL-12 and no difference was observed in the other evaluated genes. Our results also showed that the alleles of +1188 region of IL-12 and alleles of +874 of IFN-γ were also not associated with serum level of cytokines. Conclusion: According to the results of this study, it may be concluded that the polymorphisms in +1188 region of IL-12 and +874 region of IFN-γ would not affect the expression of both cytokines at serum level in OBI patients.

Background: Occult hepatitis B infection (OBI) is a form of viral hepatitis in which the HBV-DNA is present in blood while the HBsAg is undetectable. As differences in genetics and immunological responses have important role on OBI we were persuaded to analyze the known CCR5-D32 mutation (a chemokine receptor) in patients with OBI.Materials and Methods: In this descriptive study, 3700 blood samples that were HBsAg negative were collected during March 2006 to February 2007, from Rafsanjan blood transfusion services. All samples were tested for anti-HBc antibody. The HBsAg negative and anti-HBc positive samples were analyzed for HBV-DNA by PCR technique. The HBV-DNA positive samples were regarded as OBI cases. Finally, the Gap-PCR was performed to examine the d32 mutation in OBI patients. Results: The analysis of results showed that 352 (9.51%) cases of HBsAg negative samples were positive for anti-HBc. Following examination of HBsAg negative and anti-HBc positive samples for HBV-DNA by PCR based methods; we found that 57(16.1%) cases had HBV-DNA. None of the OBI patients had d32 mutation in CCR5 chemokine receptor whereas 2(2%) of controls had heterozigotic form of this mutation.Conclusion: Based on the results of this study it seems that CCR5-D32 mutation does not affect the immune response against HBV to make OBI.

H. W. Reesink, C. P. Engelfriet, G. Henn, W. R. Mayr, G. Delage, F. Bernier, T. Krusius, A. Assal, P. Gallian, C. Corbi, P. Morel, B. David, P. De Micco, H. Murokawa, H. Yugi, S. Hino, K. Tadokoro, O. Flesland, E. Brojer, M. Oe towska, G. Olim, F. Nascimento, H. Goncalves, L. Castro, M. Morais, S. L. Stezinar, M. Alvarez, S. Sauleda, R. Gonzalez, C. Niederhauser, M. Stolz, J.-P. Allain, S. Owusu-Ofori, R. Eglin, S. Stramer, M. Busch, D. M. Strong, J. Epstein, R. Biswas

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Aims Occult hepatitis B infection (OBI) may adversely affect the outcome of patients with chronic liver disease (CLD). There are no data on OBI and CLD in children. This study determined the prevalence and effect of OBI in HBsAg-negative CLD children. Materials and methods CLD children were prospectively evaluated with a demographic, clinical, and investigative proforma. All HBsAg-negative CLD cases were tested for exposure to hepatitis B (total anti-HBc, anti-HBs). Serum hepatitis B virus DNA was measured in exposed (total anti-HBc positive) patients. Results A total of 115 HBsAg-negative CLD children (59 boys, age 9.0±3.6 years) were enrolled. The etiology of CLD was known in 94 cases and 21 children had cryptogenic CLD. Of these, 45 (39.1%) had evidence of HBV exposure (23 total anti-HBc positive, 17 total anti-HBc and anti-HBs positive, five only anti-HBs positive without previous vaccination). The anti-HBc-positive children had a higher Child's score than the anti-HBc-negative children [11 (5-13) vs. 7 (5-13); P=0.00]. A total of 4/45 children had seropositive OBI with serum HBV DNA of 8, 36, 133, and 156 IU/ml, respectively. The proportion of total anti-HBc positivity (8/21 vs. 32/94; P=0.8) and OBI (2/21 vs. 2/94; P=0.1) was similar in cryptogenic CLD and known cause CLD. Conclusion Seropositive OBI is infrequent in Indian children with CLD. The prevalence is similar in cryptogenic and CLD of known etiology.