Occult Hepatitis B Virus Infection and Its Risks of Cryptic Transmission in Southern Ethiopia

Abstract

The detection of hepatitis B virus surface antigen (HBsAg) in serum remains the mainstay in diagnosing and screening of hepatitis B virus (HBV) in most developing countries. The absence of HBsAg in the blood may not indicate the absence of circulating HBV and might be infectious. Thus, this study aimed to estimate the burden and its cryptic transmission risks of occult hepatitis B infection (OBI) among HBsAg negative healthy individuals in Southern Ethiopia. Methods: A community-based cross-sectional study was conducted from September 2020 to January 2021. Serum samples were collected and assayed for HBsAg and HBV core antibody (anti-HBc) seromarkers using enzyme-linked immunosorbent assay (ELISA). In anti-HBc positive samples, HBV DNA was detected using real-time polymerase chain reaction (RT-PCR). Data were entered into Epi-Data version 3.1, cleaned, and analyzed using SPSS version 21.0. Descriptive and logistic regression analyses were employed. Statistical significance was decided at p < 0.05. Results: A total of 346 were individuals included in this study; 34 (9.8%) were tested positive for HBsAg. The rest 312 (90.2%) negatively tested were further assayed for anti-HBc, and 115 (36.7%) were found positive implying previous exposure to HBV, and 21 (18.3%) out of 115 anti-HBc positives had HBV DNA signifying OBI. The HBV DNA concentration below 200 IU/mL was 85.7%. A high rate of OBI was observed among individuals who had multiple sexual contacts, a family history of hepatitis, and tattooing. Conclusion:In this study, the prevalence of OBI is high. This indicates the burden of HBV is considerable since screening is exclusively dependent on HBsAg which will not eliminate the possibility of residual cryptic transmission through blood donation, organ transplantation, perinatal transmission, and other contacts. Our results demonstrate that nucleic acid-based testing (NAT) should be an essential part of screening to prevent missing OBI.

HBV Genetic Diversity and Transfusion Safety: A Conceptual Analysis and Integrative Model

“…This provided a panoramic view of the spectrum of existing definitions and allowed the development of an integrative model based on a literature dataset of over 80 comprehensive texts. In this way, this work adds to previous studies, which have been limited to the comparison of only a few definitions [35][36][37][38][39][40][41][42] or were less comprehensive [43][44][45].…”

Insight on the hepatitis B virus and host immune mechanisms in the context of occult hepatitis

“…43 Such findings suggest that anti-HBc does not result in complete HBV exclusion. 44 HBV is highly prevalent in most African countries, such as Ethiopia which is a high endemic setting for HBV infection according to the World Health Organization (WHO) criteria (≥8.0%). 45 Thus, this observed seroprevalence of HBsAg is comparable with previous reports investigating the national pooled prevalence (7.4%) and subgroup meta-analysis prevalence (8.0%) in community-based studies in Ethiopia (2016).…”

Advances in isothermal nucleic acid amplification methods for hepatitis B virus detection

“…6 As NAT is a fundamental tool that can detect trace amounts of DNA or RNA and is widely used in the identification of other microorganisms, [7][8][9] many researchers demonstrated and suggested that NAT could be an essential part of HBV screening to prevent missing OBI. [10][11][12][13] Besides, quantification of HBV DNA proved to be a useful strategy for staging patients, monitoring the treatment effectiveness, identifying viral resistance occurrence and selecting treatment regimens. [14][15][16][17] In recent years, the field of nucleic acid detection has seen exponential growth in research and development, with most studies focusing on PCR-based approaches.…”