Abstract
Persistence of the hepatitis B virus (HBV) genome in individuals negative for the HBV surface antigen (HBsAg) reflects occult infection. The aim of this study was to identify occult HBV infection among hemodialysis patients at 5 clinics in Recife, State of Pernambuco, Brazil, between August 2006 and August 2007. Serum samples underwent enzyme-linked immunosorbent assay to investigate total antibodies against HBcAg (anti-HBc), HBsAg, and antibodies against HBsAg (anti-HBs). Samples that were HBsAg-negative were tested for total anti-HBc, and those that were positive for total anti-HBc were tested for anti-HBs. HBV DNA was investigated with an in-house PCR technique to identify samples positive for total anti-HBc. Subsequently, the samples positive for HBV DNA were sequenced to identify the genotype and mutations. The study population (n = 752) had a mean age of 50 15.1 years and included both sexes. All samples analyzed were negative for HBsAg. The seroprevalence of total anti-HBc was 26.7% (201/752), while that of anti-HBs was 67.2% (135/201). Total anti-HBc alone was detected in 5.7% of the patients. Occult infection was found in 1.5%, comprising genotypes A (33.3%, 1/3) and D (66.7%, 2/3). No mutations were found. The study detected occult hepatitis B virus infection in hemodialysis patients. Molecular studies on HBV are of fundamental importance because they identify patients that had been considered virus-negative but who, in reality, host the virus and have the ability to transmit it to other patients and staff.
Highlights
Persistence of the hepatitis B virus (HBV) genome in individuals negative for the HBV surface antigen (HBsAg) reflects occult infection
The frequency of occult infection among the hemodialysis patients studied corroborates the results in the literature
Hemodialysis patients present high susceptibility to acquiring HBV if the clinics do not follow the universal precautions recommended in the Board Collegiate Resolution, Resolução da Diretoria Colegiada (RDC) No 154, by the Brazilian Ministry of Health[24]
Summary
Persistence of the hepatitis B virus (HBV) genome in individuals negative for the HBV surface antigen (HBsAg) reflects occult infection. All samples analyzed were negative for HBsAg. The seroprevalence of total anti-HBc was 26.7% (201/752), while that of anti-HBs was 67.2% (135/201). Conclusions: The study detected occult hepatitis B virus infection in hemodialysis patients. Patients with liver disease and individuals at high risk of parenterally transmitted infections, such as drug users, hemophiliacs, and hemodialysis users, have been widely investigated for occult HBV3. In Brazil, a crosssectional population-based study conducted on 1,536 individuals living in rural areas found that 11 individuals were positive for total antibodies to HBcAg (anti-HBc) alone, of which 2 (18%) were HBV DNA-positive[11]
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