Control of occult hepatitis B virus infection

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.

Immunoinformatics and Evaluation of Peptide Vaccines Derived from Global Hepatitis B Viral HBx and HBc Proteins Critical for Covalently Closed Circular DNA Integrity

“…Using conserved epitopes predicted from global consensus sequences against NS3-4A could offer broader protection against multiple isotypes of the Hepatitis C virus [49]. Given the significant role of viral HBx and HBc proteins in association with cccDNA in promoting HBV replication, achieving a functional HBV cure remains a formidable challenge [50][51][52][53][54][55][56][57][58]. This study paves the way for designing innovative anti-HBV vaccines and therapeutics.…”

Occult hepatitis B virus infection and current perspectives on global WHO 2030 eradication

“…In vitro and in vivo studies have shown that the acetylation status of histones (H3/H4) connected to cccDNA controls HBV transcriptional and replicational activity. While it is plausible that these epigenetic mechanisms contribute to the potent inhibition of viral replication, incredibly low levels of cccDNA in the absence of HBsAg persist in OBI patients 19 …”

“…HBV reactivation is mainly linked to several factors, such as patients with detectable HBV DNA (even with a low viral load) who are negative for anti‐HBs antibodies, 14,19 a history of HBV infection and a history of HBV infection in the family; older age (>65); male gender; and chronic illness. The complexity of HBV reactivation in OBI patients necessitates ongoing research, and there are relationships between variables, including morbidity, etiology, therapy, and prevention.…”