Development of occult hepatitis B viral infection in pregnancy: implications for antenatal screening in women from endemic areas

Abstract

Summary: Occult hepatitis B virus (HBV) infection, manifest clinically by the presence of HBV deoxyribonucleic acid (HBV DNA) in peripheral blood in individuals who test negative for the HBV surface antigen (HBsAg), may occur in various clinical contexts, including under the influence of pharmacological immunosuppression in patients from areas endemic for HBV and, hence, at risk of previous exposure. Pregnancy is a condition associated with immune suppression, but whether virus-specific immunity may be suppressed to an extent sufficient to allow occult HBV infection to develop is currently unknown. This is potentially relevant not only to the mother's health but also because vertical transmission has been reported in the occult HBV infection setting. We report a 30-year-old woman from a country endemic for HBV who, prior to pregnancy, was persistently HBsAg-negative with undetectable HBV DNA in peripheral blood, in whom HBV DNA became increasingly detectable during pregnancy, peaking in the third trimester, before returning to undetectable levels postpartum. HBsAg remained negative and liver function tests were normal throughout. Immunoglobulin M hepatitis B core antibody, a marker of the possibility of acquisition of a new HBV infection, was also negative. The baby received immunization against HBV infection from birth and has remained HBV negative at six months. This report documents for the first time that occult HBV infection may develop during pregnancy. Further data are required regarding the prevalence of this phenomenon, predisposing factors, impact on maternal health and risk of vertical transmission so that implications for current antenatal screening strategies that do not include measurement of HBV DNA in peripheral blood can be properly determined.

Hepatitis B virus infection among sexually active individuals in Nigeria: a cross-sectional study

“…Interestingly, four of the people with occult HBV infections were pregnant women ( Table 5 ). Pregnancy leads to a state of immune suppression which may enable the development of an occult infection, although this is yet to be verified [ 32 ]. This hypothesis however opens up a research gap on the relationship between pregnancy state and occult infection in Nigeria.…”

Effect of obligatory Hepatitis B vaccination program on the prevalence of occult hepatitis B among pregnant women in Egypt: A cross sectional study

“…To the best of our knowledge, such work has not been conducted among Egyptian population before. Vertical HBV transmission may occur in the OBI setting, 14 so screening for maternal HBsAg may be insufficient and should be supplemented with neonatal immune prophylaxis. 15 Our data showed that the frequency of positive total HBc Ab in the studied cases was 4.2%, and the frequency was statistically significantly increased in unvaccinated group when compared to the vaccinated group.…”

“…While this Th2-dominant phenotype at the maternal-fetal interface allows fetal survival, the presence of anti-inflammatory cytokines such as interleukin (IL)-4 and IL-10 may predispose to an increased risk of infection, including reactivation of latent viruses, such as HBV Chang et al, 2010. 14 However, the presence of anti-HBc is not an ideal marker for the diagnosis of OBI, it is recommended to be used as a surrogate marker whenever an HBV-DNA test is not available to identify potential seropositive OBI individuals, such as in cases of blood, tissue, or organ donation, or in cases of patients undergoing immunosuppressive therapy Raimondo et al, 2008. 19 In addition, anti-HBc determination is useful, even when HBV-DNA is available, because of the possibility of intermittent viremia.…”

Frequency of Occult Hepatitis B in Pregnant Women Attending Antenatal Care Unit of a Tertiary Care Hospital

“…One research demonstrates that HBV can be transferred from mother to child even if the mother is negative for HBsAg and positive for anti-HBc. 13 To examine infants at danger for vertical transmission of HBV infection, serologic screening of pregnant women includes test for HBsAg. It is not enough being unable to perceive occult hepatitis B virus infection.…”