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. 2022 Aug 15;3(4):321-341.
doi: 10.1515/almed-2022-0065. eCollection 2022 Dec.

Control of occult hepatitis B virus infection

[Article in English, Spanish]
Marta Lalana Garcés  1   2 , Oihana Ortiz Pastor  1   3 , Gemma Solé Enrech  1   4 , Armando R Guerra-Ruiz  1   5 , Gregori Casals Mercadal  1   6 , Alejandro Almería Lafuente  1   7 , María Antonieta Ballesteros Vizoso  1   8 , Pablo Gabriel Medina  1   9 , Sergio Salgüero Fernández  1   10 , Angielys Zamora Trillo  1   11 , Isabel Aured de la Serna  12 , Juan Carlos Hurtado  13   14 , Sofía Pérez-Del-Pulgar  15 , Xavier Forns  15 , Manuel Morales Ruiz  1   6   16
Affiliations

Control of occult hepatitis B virus infection

[Article in English, Spanish]
Marta Lalana Garcés et al. Adv Lab Med. .

Abstract

Background: The diagnosis of hepatitis B virus (HBV) infection requires HBV DNA testing and serologic testing for detection of the surface antigen (HBsAg) and the hepatitis B core antibody (anti-HBc). There is a population of patients with occult HBV infection (OBI), which is not detected by HBsAg or HBV DNA quantification in blood, despite the presence of active replication in the liver.

Scope: This document provides a definition of OBI and describes the diagnostic techniques currently used. It also addresses the detection of patients with risk factors and the need for screening for OBI in these patients.

Summary: Correct diagnosis of OBI prevents HBV reactivation and transmission. Diagnosis of OBI is based on the detection of HBV DNA in patients with undetectable HBsAg in blood.

Perspectives: A high number of patients with OBI may remain undiagnosed; therefore, screening for OBI in patients with factor risks is essential. For a correct diagnosis of OBI, it is necessary that new markers such as ultrasensitive HBsAg are incorporated, and a more comprehensive marker study is performed by including markers such as cccDNA.

Keywords: covalently closed circular DNA (cccDNA); occult HBV infection (OBI); ultra-sensitive hepatitis B virus surface antigen (ultra-sensitive HBsAg).

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Conflict of interest statement

Competing interests: Authors state no conflict of interest.

Figures

Figure 1:
Figure 1:
Second HBsAg structure. Major hydrophobic regions (amino acids 107–167) and the “a” determinant (amino acids 124–147) are represented by circles with the name of the respective amino acid (1-letter code). The “a” determinant is the immunodominant epitope, which is maintained through two disulfide bonds C124–C137 and C139–C147. One of the most frequent mutations is shown in violet. Adapted from Rios-Ocampo et al. and Jaramillo et al. [4, 8].
Figure 2:
Figure 2:
Phases of VHB persistence and reactivation. The continuous red curve indicates viral replication activity in acute, chronic, and occult phases. The blue dotted line indicates a hypothetic full resolution phase. The red dotted curve represents viral replication activity in the reactivation phase. HBeAg: hepatitis B e antigen; HBsAg: hepatitis B surface antigen; cccDNA: covalently closed circular DNA (modified from Shi et al. [16])
See this image and copyright information in PMC

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