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      Control of occult hepatitis B virus infection

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          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.

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          Most cited references49

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          EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection.

          Pietro Lampertico, Kosh Agarwal, Thomas Berg … (2017)
          Hepatitis B virus (HBV) infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. This Clinical Practice Guideline presents updated recommendations for the optimal management of HBV infection. Chronic HBV infection can be classified into five phases: (I) HBeAg-positive chronic infection, (II) HBeAg-positive chronic hepatitis, (III) HBeAg-negative chronic infection, (IV) HBeAg-negative chronic hepatitis and (V) HBsAg-negative phase. All patients with chronic HBV infection are at increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC), depending on host and viral factors. The main goal of therapy is to improve survival and quality of life by preventing disease progression, and consequently HCC development. The induction of long-term suppression of HBV replication represents the main endpoint of current treatment strategies, while HBsAg loss is an optimal endpoint. The typical indication for treatment requires HBV DNA >2,000IU/ml, elevated ALT and/or at least moderate histological lesions, while all cirrhotic patients with detectable HBV DNA should be treated. Additional indications include the prevention of mother to child transmission in pregnant women with high viremia and prevention of HBV reactivation in patients requiring immunosuppression or chemotherapy. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance, i.e., entecavir, tenofovir disoproxil or tenofovir alafenamide, represents the treatment of choice. Pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not generally recommended. All treated and untreated patients should be monitored for treatment response and adherence, and the risk of progression and development of complications. HCC remains the major concern for treated chronic hepatitis B patients. Several subgroups of patients with HBV infection require specific focus. Future treatment strategies to achieve 'cure' of disease and new biomarkers are discussed.
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            Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.

            Norah Terrault, Anna Lok, Brian McMahon … (2018)
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              Update of the statements on biology and clinical impact of occult hepatitis b virus infection

              Giovanni Raimondo, Stephen L. Locarnini, Teresa Pollicino … (2019)
              In October 2018 a large number of international experts with complementary expertise came together in Taormina to participate in a workshop on occult hepatitis B virus infection (OBI). The objectives of the workshop were to review the existing knowledge on OBI, to identify issues that require further investigation, to highlight both existing controversies and newly emerging perspectives, and ultimately to update the statements previously agreed in 2008. This paper represents the output from the workshop.
              Article 0 comments Cited 152 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Marta Lalana Garcés
                Journal
                Journal ID (nlm-ta): Adv Lab Med
                Journal ID (iso-abbrev): Adv Lab Med
                Journal ID (publisher-id): almed
                Journal ID (doi): almed
                Title: Advances in Laboratory Medicine
                Publisher: De Gruyter
                ISSN (Electronic): 2628-491X
                Publication date (Electronic, collection): December 2022
                Publication date (Electronic, pub): 15 August 2022
                Volume: 3
                Issue: 4
                Pages: 321-330
                Affiliations
                universityComisión de Valoración Bioquímica de la Enfermedad Hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML) , Barcelona, Spain
                universityServicio de Análisis Clínicos, Hospital de Barbastro , Huesca, Spain
                universityServicio de Bioquímica Clínica, Hospital Universitario Miguel Servet , Zaragoza, Spain
                universityServei de laboratori, UDIAT-CD, Corporació Sanitaria Parc Taulí , Sabadell, Spain
                universityServicio de Análisis Clínicos, Hospital Universitario Marqués de Valdecilla , Santander, Spain
                universityServicio de Bioquímica y Genética Molecular, CDB, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD , Barcelona, Spain
                universityServicio de Bioquímica Clínica, Hospital Royo Villanova , Zaragoza, Spain
                universityServicio de Análisis Clínicos, Hospital Universitario Son Espases , Palma de Mallorca, Spain
                universityServicio de Bioquímica Clínica, Hospital Universitari Vall d’Hebron , Barcelona, Spain
                universityServicio de Análisis Clínicos, Hospital Universitario Fundación Alcorcón , Madrid, Spain
                universityServicio de Bioquímica Clínica, Hospital General Universitario Gregorio Marañón , Madrid, Spain
                universityServicio de Digestivo, Hospital de Barbastro , Huesca, Spain
                universityServicio de Microbiología, CDB, Hospital Clínic de Barcelona, Universitat de Barcelona , Barcelona, Spain
                universityInstituto de Salud Global de Barcelona (ISGlobal) , Barcelona, Spain
                universityServicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD , Barcelona, Spain
                universityDepartamento de Biomedicina de la Facultad de Medicina y Ciencias de la Salud-Universidad de Barcelona , Barcelona, Spain
                Author notes
                Corresponding author: Marta Lalana Garcés, universityComisión de Valoración Bioquímica de la Enfermedad Hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML) , Barcelona, Spain; and universityServicio de Análisis Clínicos, Hospital de Barbastro , Carretera Nacional 240 s/n, CP 22300, Barbastro, Huesca, Spain, E-mail: mlalana@ 123456salud.aragon.es
                Author information
                https://orcid.org/0000-0001-8896-8611
                https://orcid.org/0000-0003-1204-4169
                Article
                Publisher ID: almed-2022-0065
                DOI: 10.1515/almed-2022-0065
                PMC ID: 10197267
                SO-VID: ee666337-4a2f-46f9-b45a-7ad41a7ec2cd
                Copyright © © 2022 the author(s), published by De Gruyter, Berlin/Boston
                License:

                This work is licensed under the Creative Commons Attribution 4.0 International License.

                History
                Date received : 13 November 2022
                Date accepted : 21 April 2022
                Related
                Page count
                Figures: 02, Tables: 03, References: 50, Pages: 10
                Funding
                Funded by: Ministry of Economy and Competitiveness
                Award ID: (PDI2019-105502RB-100 to MM-R)
                Funded by: CIBERehd
                Award ID: The Instituto de Salud Carlos III
                Categories
                Subject: Review

                Keywords: covalently closed circular dna (cccdna),occult hbv infection (obi),ultra-sensitive hepatitis b virus surface antigen (ultra-sensitive hbsag)
                Data availability:
                Keywords: covalently closed circular dna (cccdna), occult hbv infection (obi), ultra-sensitive hepatitis b virus surface antigen (ultra-sensitive hbsag)

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