Exposure to multiple small doses of hepatitis B virus (HBV) is a frequent occurrence in high-risk groups, including close relatives of infected individuals, primary care givers, and intravenous drug users. It remains uncertain whether such repeated contact may culminate in a symptomatic infection coinciding with hepatitis in individuals not immunoprotected. In this study, we evaluated consequences of multiple exposures to small, liver-nonpathogenic amounts of infectious hepadnavirus in the woodchuck model of hepatitis B. Virus-naïve animals were intravenously injected with 6 weekly doses of 110 DNase digestion-protected virions of woodchuck hepatitis virus (WHV), injected again with 6 weekly 110-virion doses after 7.5 months, and then challenged or not with a liver-pathogenic dose of 1.1 ؋ 10 6 virions of the same inoculum. The data revealed that two rounds of such repeated exposure did not result in serologically evident infection or hepatitis. However, a low-level WHV DNA-positive infection accompanied by a WHV-specific T cell response in the absence of antiviral antibody reactivity was established. The kinetics of the virus-specific and mitogen-induced (generalized) T cell responses and the inability to induce immunoprotection against challenge with a large, liver-pathogenic virus dose were closely comparable to those previously reported for occult infection initiated by a single liver-nonpathogenic dose of WHV. Thus, repeated exposures to small quantities of hepadnavirus induce molecularly evident but serologically silent infection that does not culminate in hepatitis or generate immune protection. The findings imply that the HBV-specific T cell response encountered in the absence of serological markers of infection likely reflects ongoing occult infection.
Multiple exposures to small amounts of hepatitis B virus (HBV) are of frequent occurrence in both occupational and nonoccupational settings (1-6). Routine vaccination against HBV prevents infection potentially caused by such exposure. However, consequences of repeated contacts with small quantities of HBV of individuals not immunoprotected against the virus are not recognized and it is unknown whether such exposure can culminate in a serologically detectable infection and hepatitis.The data acquired from the woodchuck model of hepatitis B showed that exposure to a singular low dose (i.e., Ͻ1,000 virions) of woodchuck hepatitis virus (WHV), which is a close relative of HBV (7-9), establishes serologically undetectable infection in which the virus genome and its replication are detectable when nucleic acid amplification assays of enhanced sensitivity are applied (10-13). This molecularly evident but immunovirologically silent infection was designated primary occult infection (POI) (12,14). POI was originally uncovered in offspring born to woodchuck dams convalescent from experimental acute hepatitis (AH) (15). In these animals, WHV DNA was identified in serum and in the immune system but not in the liver and virus replication progressed at a very low level ...