Prevalence of markers of hepatitis B in the adult German population

Jilg, Wolfgang; Hottenträger, Barbara; Weinberger, Klaus M.; Schlottmann, Klaus; Frick, E; Holstege, Axel; Schölmerich, Jürgen; Palitzsch, Klaus‐Dieter

doi:10.1002/1096-9071(20000201)63:2<96::aid-jmv1002>3.0.co;2-c

Cited by 68 publications

(34 citation statements)

References 20 publications

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“…Forty-four of 545 "anti-HBc alone" patients had circulating HBV-DNA with less than 1 000 copies/ml. Depending on the sensitivity of the PCR assay, the proportion of HBV-DNA carriers in this study (8.1%; detection limit 50 HBV-DNA-copies/ml) complies with other studies reporting carrier rates of 3.3% and 7.7% (detection limits of 5 000 and 100 HBV-DNA copies/mL, respectively) in unselected German individuals or blood donors [2,6] . Even more "anti-HBc alone" individuals with very low viremia would probably be found if the sensitivity of the assay were increased.…”

Section: Discussionsupporting

confidence: 90%

“…However, the detection of "anti-HBc alone" (as the only marker of HBV infection) is not an infrequent serological pattern. In areas with low HBV prevalence (most parts of Europe and the United States) "anti-HBc alone" is found in 10-20% of all individuals with HBV markers, according to 1-4% of the general population [1,2] . This pattern poses problems because it provides no exact diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

Knöll¹

2006

WJG

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AIM:To investigate the prevalence and clinical significance of "anti-HBc alone" in an unselected population of patients and employees of a university hospital in southern Germany. METHODS:All individuals with the pattern "anti-HBc alone" were registered over a time span of 82 mo. HBV-DNA was measured in serum and liver samples, and clinical charts were reviewed. RESULTS:Five hundred and fifty two individuals were "anti-HBc alone" (of 3004 anti-HBc positive individuals; 18.4%), and this pattern affected males (20.5%) more often than females (15.3%; P < 0.001). HBV-DNA was detected in serum of 44 of 545 "anti-HBc alone" individuals (8.1%), and in paraffin embedded liver tissue in 16 of 39 patients tested (41.0%). There was no association between the detection of HBV genomes and the presence of biochemical, ultrasonic or histological signs of liver damage. Thirty-eight "anti-HBc alone" patients with cirrhosis or primary liver carcinoma had at least one additional risk factor. HCV-coinfection was present in 20.4% of all individuals with "anti-HBc alone" and was the only factor associated with a worse clinical outcome. CONCLUSION:In an HBV low prevalence area, no evidence is found that HBV alone causes severe liver damage in individuals with "anti-HBc alone". Recommendations for the management of these individuals are given.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

Knöll¹

2006

WJG

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“…28 In the general population, the prevalence of anti-HBs and antiHBc indicating resolved HBV infection is 5-20% in the US 29 and about 7% in Germany, 30 respectively. As HSCT is performed for an increasing variety of malignant or genetic disorders, a significant number of HSCT patients are at risk for HBV reactivation.…”

Section: Discussionmentioning

confidence: 99%

Reactivation of resolved hepatitis B virus infection after allogeneic haematopoietic stem cell transplantation

Knöll

Boehm

Hahn

et al. 2004

Bone Marrow Transplant

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Summary:Hepatitis B virus (HBV) reactivation after allogeneic haematopoietic stem cell transplantation (allo-HSCT) is well known in HBsAg-positive carriers but has only occasionally been reported in patients with resolved HBV infection. We investigated six allo-HSCT recipients with pretransplant anti-HBs and anti-HBc antibodies for serologic markers of HBV infection and for the presence of HBV-DNA in serum. Reverse seroconversion, that is, reappearance of HBsAg after a gradual loss of anti-HBs, but no severe liver damage was observed in three patients at 14, 22 and 12 months after HSCT, respectively. There was an increase in HBV-DNA concentration prior to reverse seroconversion. One patient was repeatedly HBV-DNA positive (10 2 -10 3 copies/ml) without reverse seroconversion. Sequencing of the HBsAg and precore region derived from the four HBV-DNA-positive patients showed no relevant mutations. In conclusion, this study demonstrated a high risk (50%) of reverse seroconversion in allo-HSCT recipients with resolved HBV infection. A highly sensitive HBV-DNA assay (TaqMan-PCR) allowed early identification of the individual patients at risk. Reactivation of HBV is a well-known complication in patients with chronic hepatitis B virus (HBV) infection undergoing immunosuppressive or cytotoxic therapy. HBsAg-positive recipients of haematopoietic stem cell transplantation (HSCT) have a higher incidence of clinical hepatitis associated with HBV reactivation, most often during immunological recovery. 1 The proposed mechanism is an increase in viral replication in the liver during the period of immunosuppression, followed by an immune mediated destruction of infected hepatocytes after cessation of immunosuppressive therapy. The risk of fatal HBV liver disease among patients who are persistently HBsAg positive after HSCT is approximately 12%. 2 HBV reactivation has also been observed in HBsAgnegative HSCT recipients with antibodies against HBs and HBc antigens (anti-HBs and anti-HBc, respectively), that is, in patients with resolved HBV infection. Therefore, the presence of these antibodies does not necessarily reflect viral clearance. In individuals with resolved infection, HBV has been shown to persist in a 'latent' state in the liver and in peripheral blood mononuclear cells. 3,4 However, there are no data about the percentage of patients who keep a transcriptionally active HBV genome for years or decades after complete clinical and serological recovery from acute hepatitis. In these patients, immunosuppression and loss of recipient B and T cell repertoire during allo-HSCT may lead to viral reactivation with reappearance of HBsAg after a gradual loss of anti-HBs; this has been termed 'reverse seroconversion'. To further characterize the risk of HBV reactivation in allo-HSCT recipients with resolved HBV infection, we investigated consecutive serum samples from six anti-HBs and anti-HBc-positive patients after allo-HSCT for the presence of HBV-DNA and for serologic markers of HBV infection. Methods and patients PatientsFrom 1...

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“…28 Although the frequency of viral reactivation among HBsAg-positive patients with cancer would be expected to be the same irrespective of geographical area, the prevalence of HBV infection varies between different populations from 10% to 25% in endemic areas to less than 1% in others. 3,10,29 As a result, there would be proportional difference in the incidence of viral reactivation in a given population. …”

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confidence: 99%

Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy

2006

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It is estimated conservatively that more than one third of the world's population has been infected with the hepatitis B virus (HBV) and that there are 350 million people with chronic infection, 75% of whom live in Southeast Asia and the Western Pacific regions. [1][2][3] Reactivation of HBV infection is now a well-recognized complication in infected patients who undergo cytotoxic chemotherapy for cancer. The condition ranges from asymptomatic self-limiting anicteric hepatitis to severe, potentially fatal progressive decompensated hepatitis. With the increasing use of potent cytotoxic chemotherapy, reactivation of hepatitis B in endemic regions is becoming a common clinical problem. This adversely affects advances made in various forms of cancer therapy. In this review, we consider the diagnosis, prevention, and management of HBV reactivation in association with chemotherapy and hematopoietic stem cell transplantation, particularly in light of the availability of effective prophylactic antiviral therapy.Reactivation of HBV was first described by Wands et al., 4 who in 1975 reported the condition in 20 patients with lympho-and myeloproliferative disorders. Most of the cases reported since were similar in patients with hematological malignancies-in particular, lymphomas. [4][5][6][7][8][9][10][11][12][13][14][15][16] The skewed observations may be due to the fact that these patients are often subjected to intense myelosuppressive treatment regimens, the malignancies per se are often associated with an immunocompromised state, and the patients have been consistently reported to have a higher rate of hepatitis B surface antigen (HBsAg) seropositivity than the normal population. 9,[17][18][19] Over the past decade, HBV reactivation has been increasingly observed in patients with solid tumors. [18][19][20][21][22] In patients with hepatocellular carcinoma (85% of whom have chronic HBV infection in Southern China 3,23 ), hepatitis following systemic chemotherapy has been reported in 60% 20,24 ; this is mostly attributed to HBV reactivation, which has a 30% mortality rate. 20 In other cancer subpopulations, the incidence of HBV reactivation ranges between 25% and 40%. 10,15,18,21,25 In the setting of hematopoietic stem cell transplantation (HSCT) for various hematological and oncological conditions, HBV reactivation has been reported in over 50% of patients. [26][27][28] This is related to the intense chemotherapy with or without total body irradiation, and the coexistence of acute graft-versus-host disease. 28 Although the frequency of viral reactivation among HBsAg-positive patients with cancer would be expected to be the same irrespective of geographical area, the prevalence of HBV infection varies between different populations from 10% to 25% in endemic areas to less than 1% in others. 3,10,29 As a result, there would be proportional difference in the incidence of viral reactivation in a given population. Definitions and DiagnosisIn early reports, the diagnosis of HBV reactivation was based on HBsAg and hepatitis B ...

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Prevalence of markers of hepatitis B in the adult German population

Cited by 68 publications

References 20 publications

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

Serological pattern “anti-HBc alone”: Characterization of 552 individuals and clinical significance

Reactivation of resolved hepatitis B virus infection after allogeneic haematopoietic stem cell transplantation

Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy

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