Abstract
Background and Aims: Occult hepatitis B virus infection (OBI) is known as an important source of hepatitis B virus (HBV) infection. It is categorized as Hepatitis B surface antigen (HBsAg) not being present and low DNA viral load in serum. In this study, an attempt was made to investigate the outbreak of anti-HBc and OBI among the HBsAg-negative donors in Golestan province.
 Materials and Methods: The present cross-sectional experiment was conducted on 3500 voluntary blood donors in Golestan province to examine the presence of human immunodeficiency viruses Ag-Ab, HBsAg, and hepatitis C virus Ab. Then, samples with negative results for the mentioned tests were screened for total HBc antibody (IgM-IgG) through ELISA technique. Afterward, HBV-DNA extraction and R-T PCR assay were conducted for all HBsAg negative samples by using Real ART HBV LC PCR kit on a Light Cycler instrument.
 Results: The study participants included 3255 (93%) male and 245 (7%) female. In general, 385 (11%) out of 3500 samples were anti-HBc positive. HBV-DNA results for every sample with either positive or negative anti-HBc were found to be negative.
 Conclusions: As the area under study has a high rate of anti-HBc outbreak (11%) without the presence of HBV-DNA, anti-HBc screening can cause blood donor deferrals and limit blood supply; therefore, the HBsAg test with high analytical sensitivity is recommended for HBV screening in this area. Regarding the cost analyses and also the status of HBV endemicity, HBsAg test along with ID-NAT is preferable, if possible, for improving blood safety.
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