Detectable HBV DNA Research Articles

Hepatitis B Virus Infection Status and Reactivation Analysis in Multiple Myeloma in China

Background: China is a highly endemic area for Hepatitis B virus (HBV) infection and HBV reactivation is an event of concern in treating patients with hematologic malignancy. However, there were very few reports regarding HBV reactivation in patients with multiple myeloma (MM) in China. Since the approval of novel agents, especially immunotherapy such as monoclonal antibody and chimeric antigen T cell immunotherapy, the risk of HBV reactivation has increased. Therefore, the study aimed to evaluate the HBV infection status in MM and explore the incidence and risk factors of HBV reactivation in MM patients in China. Methods: Newly diagnosed MM patients with available serologic assays for HBV infection were retrospectively enrolled between June 30, 2008 and December 30, 2022 in West China Hospital, Sichuan University. Demographic and clinical data were obtained from the “HemaTank” Chinese Multiple Myeloma Database (HCMMD). Meanwhile, patients diagnosed with Waldenstrom Macroglobulinemia (WM) at the same time were enrolled as the control group. HBV reactivation was defined as the occurrence of one of the following: ≥ 2 log increase in HBV-DNA levels from baseline level, detection of HBV-DNA with level > 100 IU/ml in a person with undetectable HBV DNA at baseline or HBsAg-negative becoming positive. The penalized maximum likelihood logistic regression for rare events was applied to identify independent risk factors related to HBV reactivation. Results: The study recruited 3040 MM patients with a median age of 62 (range 14~98) and 240 WM patients with a median age of 63 (range 25~92). The HBsAg-positive rates were similar between MM and WM (9.4% vs 10.8%, P=0.49), but both the HBcAb-positive rates and HBeAb-positive rates in WM were significantly higher than MM (76.3% vs 60.7%, P<0.001; 37.5% vs 25.1%, P<0.001). The analysis of co-expression of HBV markers shows that the prevalence of HBsAg-/Anti-HBs+/anti-HBC- in MM was significantly higher than WM (16.7% vs 8.3%, P<0.001) and HBsAg-/Anti-HBs-/anti-HBC+ in MM was significantly lower than WM (18.3% vs 27.1%, P<0.001). However, he prevalence of HBsAg+/ HBeAg+/anti-HBC+ and HBsAg+/ anti-HBeAb+/anti-HBC+ were similar between MM and WM (0.5% vs 1.3%, P=0.158; 8.6% vs 8.8%, P=0.503). The baseline characteristics of HBsAg-positive MM and HBsAg-negative MM were summarized in Table 1. The rates of HBsAg-positive MM were significantly increased in young male patients (P<0.05). The level of ALT and AST, and the incidence of HBV reactivation, liver cirrhosis and pulmonary disease were significantly higher in HBsAg-positive MM than in HBsAg-negative MM (P<0.05). Of the 2147 MM patients who have received at least one line of chemotherapy (Table 1), 924 (43%) MM patients received bortezomib-containing or lenalidomide-containing regimens as the frontline therapy, while only 21 (1.0%) received a daratumumab-containing regimen as the frontline therapy. During hospital-documented follow-up visits, 26 (1.21%) MM patients have experienced HBV reactivation. According to the multivariate analysis of risk factors for HBV reactivation in MM, liver cirrhosis (OR 8.63, 95%CI 2.95-25.24, P<0.001), autologous stem cell transplantation (OR 6.03, 95%CI 2.47-14.72, P<0.001) and HBsAg-positive (OR 14.45, 95%CI 6.50-32.14, P<0.001) were independent risk factors associated with high prevalence of HBV reactivation. The ROC curve of the model integrating the three factors is shown in Figure 1, and the AUC was 0.8584. Conclusions: Among Chinese MM patients with multiple myeloma, a high proportion of MM patients presented with resolved hepatitis B virus infection, whereas HBV reactivation was pretty rare. However, long-term HBV DNA levels monitoring is still needed for MM patients at high risk for HBV reactivation.

Ultrasensitive PCR system for HBV DNA detection: Risk stratification for occult hepatitis B virus infection in English blood donors.

Occult hepatitis B (HBV) infection (OBI), characterized by low viral loads, accounts for much of the risk of HBV transfusion-transmitted infection. With anticore antibodies (anti-HBc) screening introduced in England, the imperative to identify OBI donors has increased. We aimed to develop an ultra-sensitive PCR system and investigate risk factors for HBV DNA presence in blood donations. Seven extraction methods and three PCR assays were compared. The optimal system was sought to determine HBV DNA presence in anti-HBc-positive donations. Predictors of DNA positivity were subsequently investigated. Extraction from 5 mL of plasma increased sample representation and resulted in HBV DNA detection in low viral load samples (~0.5 IU/mL). Screening of 487 763 donations in 2022 identified two OBI donors and 2042 anti-HBc-positive donors, 412 of the latter with anti-HBs < 100 mIU/mL. Testing of 134 anti-HBc-positive donations utilizing the 5 mL extraction method identified two further HBV DNA-positive donations. Higher anti-HBc titer and anti-HBs negativity were significant predictors of DNA detectability in anti-HBc-positive donations. An ultrasensitive PCR assay identified potentially infectious donations increasing HBV DNA detection in anti-HBc-positive donors from 0.5% to 1.9%. Anti-HBc titers may further complement the risk stratification for DNA positivity in anti-HBc screening and minimize unnecessary donor deferral.

Assessing and improving the quality of guideline-adherent hepatitis B virus care in people with HIV: A cross-sectional study.

The increasing use of non-tenofovir containing antiretroviral regimens calls for renewed attention to the prevention and management of hepatitis B virus (HBV) in people with HIV (PWH). We retrospectively assessed adherence to HBV guidelines, including complete HBV screening in PWH. In people with HIV/HBV co-infection, this included HBV therapy, screening for hepatitis delta virus (HDV) and on-therapy virologic response monitoring. HIV/HBV co-infection in PWH was defined as the presence of hepatitis B surface antigen (HBsAg) at the last measurement before study entry or detectable HBV-DNA for ≥6months. After assessment, missing laboratory tests were performed to optimize HBV monitoring and screening for co-infections. Of all PWH under follow-up, 1484/1633 (90.9%) were adequately screened for HBV. After performing missing screening tests, 466 of 1618 PWH with complete screening results (28.8%) were non-immune for HBV infection. Fifty-one (3.2%) with HIV/HBV co-infection were identified. HBV treatment was adequate in 51/51 (100%). Screening for hepatitis A, C and delta virus antibodies and fibrosis was performed in 51/51 (100%), 49/51 (96.1%), 17/51 (35.3%) and 38/51 (74.5%). Annual HBV-DNA or HBsAg monitoring was done in 18/51 (35.3%) and hepatocellular carcinoma (HCC) surveillance in 2/9 (22.2%) of those indicated. Additional testing in those with missing data identified 4/34 (11.8%) persons with HDV antibodies and 3/30 (10%) with HBsAg seroclearance. Our study demonstrates the feasibility and added value of evaluating HBV care components and performing missing laboratory tests, identifying a large number of HBV vaccination candidates and HDV antibody screening, HBsAg monitoring and HCC surveillance as key areas for improvement.

“One-to-many” signal-output strategy-based CRISPR/Cas12a system for sensitive label-free fluorescence detection of HBV-DNA

Although CRISPR/Cas12a systems significantly enhance the analytical accuracy and flexibility of fluorescent biosensors, their sensitivity is limited by traditional “one-to-one” mediation types and ineffective signal-output turnover routes. Herein, we demonstrate a “one-to-many” signal-output strategy-based CRISPR/Cas12a systems resembling a “seaweed” to enhance the sensitivity. Based on dendrimer DNA from high-dimensional hybridization chain (HCR) of three hairpin-free DNA building blocks, the 3D magnetic DNA machine was created. The HBV-DNA initiates the rolling circle amplification (RCA) reaction and produces DNA nanowires to activate the CRISPR/Cas12a system. The trans-cleavage of the “seaweed root” by CRISPR/Cas12a system left dendrimer DNA in solution, thus, adding SYBR Green I (SG I) to the high-density DNA duplexes, achieving multiple-turnover label-free fluorescence signal output demonstrated and a low LOD (1.502 pM). However, in the absence of target, the blocked RCA failed to activate the CRISPR/Cas12a system, resulting in complete separation from substrate and negligible fluorescence signals. Moreover, the mandatory RCA-based pre-amplification of the DNA activator could efficiently trigger the multiple-turnover trans-cleavage activity of Cas12a. it can cleave one single-stranded linker of “seaweed-like” DNA machine, thereby releasing massive DNA duplex-enriched dendrimer DNA with a “one-to-many” signal-output turnover. By coupling the periodically extended Cas12a activator generated by RCA with hyperbranched DNA duplex by high-dimensional HCR, compact 3D extension structures were formed, achieving high-density fluorescence distribution in focal volume, avoiding signal dilution and ensuring high enhancement. Additionally, spiked recoveries in physiological media exceeded 95%, demonstrating the potential application of such platforms in clinical diagnosis.

Possible Association between Genetic Diversity of Hepatitis B Virus and Its Effect on the Detection Rate of Hepatitis B Virus DNA in the Placenta and Fetus.

Background: The prevalence of HBV infection and HBV genotypes varies from country to country, and the role of HBV genotypes in the presence of HBV in the placenta and fetus has never been explored. This study was conducted to (1) identify HBV genotypes, and their frequencies, that infected Northern Thai pregnant women; (2) evaluate the association between HBV genotypes and the detection rate of HBV DNA in the placenta and fetus; (3) evaluate the association between specific mutations of the HBV genome and HBV DNA detection in placental tissue; and (4) identify the mutation of the HBV genome that might occur between maternal blood, placenta, and cord blood. Methods: Stored samples of the maternal blood, placental tissue, and cord blood that were collected from 145 HBsAg-positive pregnant Thai women were analyzed to identify HBV DNA. Results: Approximately 25% of infected mothers had fetal HBV DNA detection, including cases with concomitant HBV DNA detection in the placenta (77.3%). A total of 11.7% of cases with placental detection had no HBV DNA detection in the maternal blood, indicating that the placenta could be a site of HBV accumulation. Of the 31 HBV-positive blood samples detected by nested PCR, the detected strains were subgenotype C1 (77.4%), subgenotype B9 (9.7%), and subgenotype C2, B2, B4, and recombinant B4/C2 (3.2% for each). Genotype B had a trend in increased risk of placental HBV DNA detection compared to genotype C, with a relative risk of 1.40 (95% CI: 1.07-1.84). No specific point mutation had a significant effect on HBV DNA detection in placental tissue. Mutation of C454T tended to enhance HBV DNA detection in placental tissue, whereas T400A tended to have a lower detection rate. No mutation was detected in different sample types collected from the same cases. Conclusions: HBV DNA detection in the fetus was identified in approximately 25% of HBV-positive mothers, associated with the presence of HBV in the placenta in most cases. The placenta could possibly be a site of HBV accumulation. Subgenotype C1 was the most common subgenotype, followed by subgenotype B9. HBV genotype B possibly had a higher trend in intrauterine detection than HBV genotype C. Mutation is unlikely to occur during intrauterine exposure.

Evaluating the cost-effectiveness of low-level HBV DNA screening in occult hepatitis B infection donors: A study from Shandong Blood Center, China

ObjectiveThis study aimed to assess the efficacy of individual-donation nucleic acid testing (ID-NAT) in detecting occult hepatitis B virus infection (OBI) among anti-HBc positive blood donors, compared to minipool nucleic acid testing (MP-NAT). MethodsThe present study analyzed data from the Shandong Blood Center in China during the period from January 2018 to June 2022, where HBsAg-negative blood donors were screened using the 6-sample minipool nucleic acid testing (6-sample MP NAT) method. NAT-positive samples underwent subsequent anti-HBc and anti-HBs testing. Approximately 5000 samples that passed the nucleic acid mixing test were randomly selected for anti-HBc testing, and over 100 anti-HBc positive samples underwent individual donor nucleic acid testing (ID-NAT). Any HBV DNA positive samples detected by ID-NAT were subsequently confirmed using alternative nucleic acid testing methods. ResultsAmong 220,445 HBsAg-negative blood donors, the positivity rate of HBV DNA detection using the 6-sample minipool nucleic acid testing (MP NAT) method was found to be 0.031% (69/220,445). Of the 67 HBV DNA positive samples, 55 (82.09%) and 25 (37.31%) were found to be positive for anti-HBc and anti-HBs, respectively, using the supplementary chemiluminescent microparticle immunoassay (CMIA). Among the 4797 HBsAg-negative/MP NAT-negative samples, 909 (18.95%) tested positive for anti-HBc. Further NAT testing was performed on 164 arbitrarily selected anti-HBc-positive/MP HBV DNA-negative samples, revealing a HBV DNA positivity rate of 1.22% (2/164). ConclusionUsing individual donation nucleic acid testing can significantly increase the detection rate of occult hepatitis B virus infection in anti-HBc-positive blood donors, resulting in a detection rate of 0.22% (1.22 × 0.1895). This rate is 8.10 times higher than the detection rate achieved by mixed testing methods (0.031%) [calculated as (0.22 + 0.031)/0.031]. Therefore, it is recommended to perform single HBV DNA testing on anti-HBc-positive blood donors, discard plasma with weakly positive or negative anti-HBs but positive anti-HBc, or avoid transfusing anti-HBc-positive plasma to recipients with weakly positive or negative anti-HBs to prevent HBV infection.

Switching from entecavir to tenofovir alafenamide for maintaining complete virological response in chronic hepatitis B.

Hepatocellular carcinoma development can be decreased by achieving and maintaining complete virological response (CVR) in chronic hepatitis B. However, it is unclear whether switching from entecavir (ETV) to tenofovir alafenamide (TAF) could achieve and maintain CVR in patients with low-level viremia (LLV; HBV DNA ≤ 3.3 log IU/mL) or occasional detectable HBV DNA during ETV treatment. Therefore, we aimed to examine whether the switching from ETV to TAF is effective in achieving CVR in patients with LLV or occasional detectable HBV DNA. This study comprised 45 patients who switched from ETV to TAF. All patients received ETV and TAF for >2 years, and the HBV DNA levels were measured every 3 months. Maintaining undetectable HBV DNA during 2-year period is defined as CVR. The primary endpoint is the CVR rate during ETV and TAF treatment. The CVR rate for each of the 2 years of ETV and TAF therapy was 33.3% (15/45) and 68.9% (31/45, P < 0.01), respectively, and the CVR rate increased by switching from ETV to TAF. In patients with occasional detectable HBV DNA during ETV treatment (22 patients), 15 achieved CVR and 7 maintained occasional detectable HBV DNA. In patients with LLV during ETV treatment (eight patients), three achieved CVR and five had occasional detectable HBV DNA. Switching from ETV to TAF increases the CVR rate in patients with LLV or occasional detectable HBV DNA and could be an alternative treatment option.

Dynamic changes in three biomarkers predict early-stage hepatocellular carcinoma in patients with chronic hepatitis B receiving antiviral therapy.

Patients with chronic hepatitis B (CHB) remain at risk for hepatocellular carcinoma during antiviral therapy. We aimed to clarify the values of alpha-fetoprotein (AFP), lectin-reactive fraction of AFP (AFP-L3), and des-γ-carboxyprothrombin (DCP) for early warning of HCC. A total of 1348 CHB patients received antiviral therapy and follow-up every 26weeks. Eighty-four patients with HCC were age-, sex-, and cirrhosis-matched with 168 controls. AFP, AFP-L3, and DCP were compared between the groups from 104weeks before HCC diagnosis (- 104w) to the time of diagnosis (0w). Of the 84 HCC patients, 60 (71.4%) had early-stage HCC, AFP increased from - 26w, and AFP-L3 and DCP increased from - 78w. However, levels were unchanged in controls. ΔAFP, ΔAFP-L3, and ΔDCP showed similar abilities for predicting HCC (P > 0.05). Receiver operating characteristic curve analysis showed that AFP had better diagnostic performance for HCC than AFP-L3, DCP, or their combination. The cut-off values of AFP, AFP-L3, and DCP were 5.3ng/mL, 1.05%, and 31.5 mAU/mL, respectively. Notably, lower AFP values were required to diagnose HCC in patients with detectable HBV DNA (4.1ng/mL) or elevated alanine aminotransferase (5.2ng/mL). Changes in AFP, AFP-L3, and DCP can help to predict HCC in CHB patients receiving antiviral therapy. A lower AFP value is needed to diagnose HCC, especially in patients with detectable HBV DNA or elevated alanine aminotransferase.

Case Report: Complete Remission of a Patient with Acute-on-chronic Liver Failure with Rare Hepatic Encephalopathy and Fever of Unknown Origin Treated with Anti-infective Therapy Combined with Psychotherapy After Artificial Liver Support System

The theme of this report is incredible psychological therapy's inspiration for fever of unknown origin (FUO). We analyzed this incredible phenomenon through psychological immunity, liver immunity, inflammation, etiology, diagnostic methods, and treatment strategies. A man, 44 years old, was dyed for more than 40 days due to abdominal distension with skin and scleral yellow, and feathers accompanied him for four days to enter the hospital. Hepatitis virus test shows HBV infection. HBV DNA detection shows negative. The detection of the respiratory tract nine-fold, tuberculosis, anemia, and gut-to-club ratio all show negative. Due to the weakness of the patient's body, we cannot cooperate with more examinations. We use blood specimens to monitor and analyze for 25 days. In short, this is a case of chronic-acute liver failure, manic, and fever, likely to be an FUO cause in terms of the treatment plan, general treatment, artificial liver treatment, surgical treatment, anti-infection therapy, and psychotherapy. The patient reached the common treatment goal after 25 days of treatment. This report aims to provide psychotherapy programs and clinical characteristics for patients with chronic-acute liver failure, manic, and FUO and provide inspirational thinking strategies for long-term blood specimen examination. The potential mechanism of psychological fever is immune disorders, and the decline in the concentration of immunoglobulin A and E may be a direct factor.

Highly sensitive plasmonic biosensor for hepatitis B virus DNA based on the surface etching of the active helical gold nanorods

As one of the most prominent global public health problems, which seriously threats public health security and human health, hepatitis B virus (HBV) infection is the main cause of liver cirrhosis and cancer. Herein, an innovative and sensitive biosensor for HBV-DNA detection was developed based on the surface etching of the helical gold nanorods (HGNRs) at single-particle level under a dark-field microscope (DFM). In this work, the unique HGNRs with high surface activity were functionalized as the optical probe, which were etched to the smooth gold nanorods and even to gold nanospheres, resulting in a distinct color and light scattering change of single particle with a more sensitive result of HBV-DNA detection than the common gold nanorods. Furthermore, the hybridization chain reaction amplification and DFM technique enabled the proposed strategy with a high sensitivity, offering the limit of detection (LOD) as low as 30.15 fM (3σ/k) and realizing sensitive detection of HBV-DNA from 0.05 to 10 pM. Moreover, the proposed strategy supplied the good specificity, which was capable of distinguishing mismatch sequence and other viral nucleic acids. In addition, this strategy was universal and provided a new idea for early diagnosis of other viral nucleic acids, such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

Prevalence of HEV RNA in Croatian blood donors.

HEV infection is asymptomatic for immunocompetent blood donors (BD). Transfused HEV-infected blood products may cause potentially hazardous HEV infection in immunocompromised patients. Evaluation of the need for routine BD HEV RNA screening primarily demands the establishment of HEV infection prevalence in Croatian BD. We tested BD samples in ID-NAT with the Procleix UltrioPlex E screening test for simultaneous detection of HBV DNA, HCV RNA, HIV-1,2 RNA, and HEV RNA (Grifols, Spain). HEV infection was confirmed with HEV RNA quantitative test (Altona Diagnostics, Germany) and HEV IgM and HEV IgG antibody test (DIA.PRO Diagnostic Bioprobes, Italy). We analysed the HEV RNA sequence and performed a phylogenetic analysis. We recorded BD's anamnestic data and dietary habits. BDs gave follow-up samples after two months and did not donate blood for six months. Between December 2021 and March 2022, we tested 8,631 donations and found four HEV RNA-positive donations, which equals to one in 2,158 donations (0.046%, 95% confidence interval, 0.018%-0.119%). Confirmatory HEV RNA testing gave results from negative to 4.73E+3IU/ml HEV RNA. Three donations were in the serological window period. We have genotyped HEV RNA of two infected BD as genotype HEV-3c. Blood donors didn't report any health problems and their diet included pork. Testing on follow-up samples presented seroconversion and no HEV RNA could be detected. The incidence of HEV RNA infection in BD in Croatia corresponds with other European data. The decision on implementation of HEV NAT screening in Croatia needs an expert team evaluation of the possible risk of TT-HEV infection.

High-Efficiency Aluminum-Metal Organic Framework/HEPES Electrochemiluminescence System for Ultrasensitive Detection of HBV DNA.

In this work, a novel aluminum metal-organic framework (Al-MOF)/N-2-hydroxyethylpiperazine-N'-ethane-sulfonic acid (HEPES) system with an excellent electrochemiluminescence (ECL) property was developed. First, Al-MOF was successfully synthesized through a one-pot solvothermal method by using 9,10-di(p-carboxyphenyl)anthracene (DPA) as the organic luminescence ligand and Al3+ as the metal node. Compared with DPA, Al-MOF showed high ECL intensity and excellent stability without an additional coreactant in the HEPES buffer. The corresponding ECL mechanism was studied in detail, verifying HEPES was not only the buffer in the system but also the coreactant of Al-MOF. In particular, the system of Al-MOF/HEPES showed a high ECL efficiency of 30.0%, taking the Ru(bpy)32+ system as the standard. In addition, the ECL signal of Al-MOF was effectively quenched by dopamine (DA). The biosensor for HBV DNA detection was constructed through the ECL signal on-off-on mode of DNA specific recognition integrated with the DNA walker signal amplification strategy. The ultrasensitive detection for HBV DNA was achieved with a linear range of 100 aM to 10 pM and a limit of detection (LOD) of 62.1 aM. This work proposed a high-efficiency Al-MOF/HEPES system, providing a new viewpoint for a coreactant-free system in the field of ECL.

The impact of early hepatitis B virus viral suppression on treatment response in entecavir‐treated hepatitis B e antigen‐positive chronic hepatitis B

AbstractTo investigate the impact of early HBV DNA suppression after receiving entecavir (ETV) on treatment response in hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients. A total of 140 baseline HBV DNA‐matched HBeAg‐positive patients receiving ETV were enrolled. Of those 70 patients achieved early virological response at week 24 (VR24 group) and the remaining 70 patients failed to achieve VR24 (non‐VR24 group). Factors of serological and virological outcomes were analyzed. Patients with pretherapy alanine aminotransferase (ALT) levels over five times upper limit of normal had a higher HBeAg seroclearance rate (P = .038). The VR24 group had the higher ratio of HBeAg seroclearance and maintained viral suppression within 96 and 144 weeks, respectively (53% and 75%, respectively). The cumulative rates of virological breakthrough (VBT) in the VR24 group and non‐VR24 group were 0% and 5.71%, 3.2% and 11.83%, 3.2% and 17.24%, 3.2% and 17.24%, and 3.2% and 21.84% from week 48 to 240, every 48 weeks, respectively (P = .006). In the multivariate analysis, undetectable HBV DNA and age at week 24 were associated with VBT (P = .02 and .006, respectively). Pretherapy ALT levels predicted a higher probability of HBeAg seroclearance. VR24 could be associated with HBeAg seroclearance and maintained viral suppression during therapy. Detectable HBV DNA at week 24 and older age could be predictive factors with an occurrence of VBT in HBeAg‐positive CHB patients treated with ETV.

Successful clinical and virological outcomes of liver transplantation for HDV/HBV-related disease after long-term discontinuation of hepatitis B immunoglobulins.

Indefinite, long-term administration of hepatitis B immunoglobulins (HBIg), together with a third generation nucleos(t)ide analog (NA), is the currently recommended prophylactic strategy to prevent viral recurrence after liver transplantation (LT) for Hepatitis Delta virus (HDV)/Hepatitis B virus (HBV)-related disease. We retrospectively analyzed the safety and long-term clinical and virological outcomes of a consecutive cohort of 16 patients (10 males, median age 64.5, range 41-75) transplanted for HDV/HBV-related cirrhosis at our Institution, who discontinued HBIg after a median of 24.5months (range 15-116) after transplant. All patients continued prophylaxis with same NA used before LT. Recurrence of HDV/HBV infection was defined as reappearance of serum HDV-RNA with detectable serum HBsAg and/or HBV-DNA. The median follow-up after LT was 138months (range 73-316) and 110months (range 52-200) after HBIg withdrawal. All patients were HBsAg-positive, HBV-DNA negative, and anti-HDV positive at the time of LT and without coinfections with HCV or HIV. Patients were followed with biochemical and virological tests every 3-6months after HBIg withdrawal. No recurrences of HDV/HBV infection or disease were observed during monoprophylaxis with NA. In addition, eight patients (50%) spontaneously developed anti-HBs titers above 10IU/L at a median of 74months (range 58-140) following HBIG discontinuation. HBIg withdrawal after LT is a safe and efficacious strategy in patients transplanted for HDV/HBV disease and is frequently associated with the spontaneous development of serological immunity against HBV. These data call for a revision of current prophylactic recommendations in this setting.

Early intrahepatic recurrence of HBV infection in liver transplant recipients despite antiviral prophylaxis

Background & AimsProphylaxis with nucleos(t)ide analogues (NUCs) and hepatitis B immunoglobulin (HBIG) has decreased the rate of HBV recurrence after orthotopic liver transplantation (OLT), but the duration of this prophylaxis remains debated. Our aim was to investigate the recurrence of both intrahepatic and serum HBV markers after OLT in patients receiving long-term NUC and HBIG prophylaxis. MethodsA total of 31 HBV-positive patients benefiting from OLT were prospectively enrolled in five French centres between 2012 and 2015. Tissue samples from the native liver, liver reperfusion biopsy, and 12-month post-OLT (M12) biopsy were collected. Intrahepatic HBV markers were quantified using Droplet Digital PCR. Serum hepatitis B core-related antigen (HBcrAg) and HBsAg were quantified using the Lumipulse platform. ResultsAmong the 31 patients, 26 were HBeAg negative and 28 had undetectable serum HBV DNA at OLT. All patients received HBIG and NUC after OLT, and serum HBV DNA was undetectable at M12. Of the 27 available native livers, 26 had detectable total HBV DNA (median, 0.045 copies/cell), 21 were positive for cccDNA (0.001 copies/cell), and 19 were positive for 3.5-kb HBV RNA (0.0004 copies/cell). Among the 14 sequential reperfusion and M12 biopsies, seven were positive for HBV markers on the reperfusion sampling, and six of them were also positive at M12. Of the 27 patients with available serum samples at M12, eight were positive for HBcrAg and five were positive for HBsAg by ultrasensitive quantification, although they were negative by conventional techniques. Overall, among the 17 patients having a matched biopsy and serum sample at M12, only one had undetectable HBV markers in both the liver and serum. ConclusionsOur results demonstrate a very early detection of viral genome in the graft and intrahepatic viral recurrence despite NUC and HBIG prophylaxis. Clinical Trials RegistrationThis study is registered at ClinicalTrials.gov (NCT02602847). Impact and ImplicationsIn this work, we show that, despite the recommended prophylaxis based on NUC and HBIG, HBV can infect the new liver very rapidly after transplantation. Twelve months after transplantation, the majority of patients had at least one HBV marker detected in either serum or the liver. Therefore, our results demonstrate early intrahepatic viral recurrence despite NUC and HBIG therapy and underline the importance of an optimal patient compliance to the antiviral prophylaxis to prevent viral rebound.

Evaluation of the efficacy of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B combined with nonalcoholic fatty liver disease by high-sensitivity detection of HBV DNA levels

Objective: To observe the efficacy of tenofovir disoproxil fumarate (TDF) antiviral therapy in patients with chronic hepatitis B (CHB) combined with nonalcoholic fatty liver disease (NAFLD), so as to provide evidence-based evidence in these special populations. Methods: Data from 91 CHB cases who received TDF 300 mg/d antiviral therapy for 96 weeks were analyzed retrospectively. Among them, 43 cases with NAFLD were included in the study group, and 48 cases without NAFLD were included in the control group. The virological and biochemical responses of the two groups of patients at 12, 24, 48, and 96 weeks were compared. Among them, 69 patients underwent highly sensitive detection of HBV DNA. The t-test and χ (2) test were performed on the data. Results: ALT normalization rate was lower in the study group (42%, 51%) at 12 and 24 weeks of treatment than that in the control group (69%, 79%), and the difference was statistically significant (P < 0.05). However, there was no statistically significant difference between the two groups at 48 and 96 weeks. HBV DNA concentration below the lower limit of detection (200 IU/ml) was lower in the study group at 12 weeks of treatment than in the control group (35% vs. 56%), and the difference was statistically significant (P < 0.05). However, there was no statistically significant difference between the two groups at 24, 48, and 96 weeks. Furthermore, HBV DNA concentration below the lower limit was significantly lower in the study group than that in the control group at 12, 24, 48, and 96 weeks of treatment when the lower limit of HBV DNA detection was set at 20IU/ml, and the difference was statistically significant (P < 0.05). The HBeAg serological negative conversion rate was gradually higher in the study group at 48 and 96 weeks of treatment than in the control group, and the difference was not statistically significant. Conclusion: TDF antiviral treatment can affect the virological and biochemical responses of NAFLD in chronic hepatitis B.

The clinical effect of antiviral therapy in patients with hepatitis B virus-related decompensated cirrhosis and undetectable DNA.

Antiviral therapy (AVT) is the mainstay of hepatitis B virus (HBV) management. We investigated whether AVT improves the outcomes of HBV-related decompensated cirrhosis and undetectable HBV-DNA. Between 2000 and 2017, treatment-naïve patients with HBV-related decompensated cirrhosis and undetectable HBV-DNA were recruited from two tertiary hospitals. The endpoints included death and hepatocellular carcinoma (HCC). A total of 429 patients were analyzed (50 and 379 patients in the AVT and non-AVT groups, respectively). Patients in the AVT group were significantly younger and had higher alanine aminotransferase and alpha-fetoprotein levels than those in the non-AVT group (all P<0.05). During follow-up (median 49.6months), 98 patients died and 105 developed HCC. The cumulative incidence rates of death (2.0%, 4.1%, and 6.4%, and 4.9%, 7.2%, and 10.2% at 6months, 1year, and 2years, respectively) and HCC (8.6%, 15.8%, and 26.4% vs 1.6%, 7.7%, and 24.4% at 1, 2, and 5years, respectively) were statistically comparable between the AVT and non-AVT groups (all P>0.05). Using Cox regression analysis, AVT was not significantly associated with death nor HCC (all P>0.05). Similar results were observed after balancing baseline characteristics with inverse probability of treatment weighting. In the non-AVT group, the cumulative incidence rates of HBV-DNA detection at 6months, 1year, and 2years were 2.0%, 3.1%, and 6.4%, respectively. Antiviral therapy did not attenuate the risk of death nor HCC in patients with HBV-related decompensated cirrhosis and undetectable HBV-DNA.

Performance of algorithms for identifying patients with chronic hepatitis B or C infection in the french health insurance claims databases using the ANRS CO22 HEPATHER cohort.

The validity of algorithms for identifying patients with chronic hepatitis B or C virus (HBV or HCV) infection in claims databases has been little explored. The performance of 15 algorithms was evaluated. Data from HBV- or HCV-infected patients enrolled between August 2012 and December 2015 in French hepatology centres (ANRS CO22 HEPATHER cohort) were individually linked to the French national health insurance system (SNDS). The SNDS covers 99% of the French population and contains healthcare reimbursement data. Performance metrics were calculated by comparing the viral status established by clinicians with those obtained with the algorithms identifying chronic HBV- and HCV-infected patients. A total of 14 751 patients (29% with chronic HBV and 63% with chronic HCV infection) followed-up until December 2018 were selected. Despite good specificity, the algorithms relying on ICD-10 codes performed poorly. By contrast, the multi-criteria algorithms combining ICD-10 codes, antiviral dispensing, laboratory diagnostic tests (HBV DNA or HCV RNA detection and quantification, HCV genotyping), examinations for the assessment of liver fibrosis and long-term disease registrations were the most effective (sensitivity 0.92, 95% CI, 0.91-0.93 and specificity 0.96, 95% CI, 0.95-0.96 for identifying chronic HBV-infected patients; sensitivity 0.94, 95% CI, 0.94-0.94 and specificity 0.85, 95% CI, 0.84-0.86 for identifying chronic HCV-infected patients). In conclusion, the multi-criteria algorithms perform well in identifying patients with chronic hepatitis B or C infection and can be used to estimate the magnitude of the public health burden associated with hepatitis B and C in France.

Molecular Detection of Hepatitis B Virus Among HBsAg Non-Reactive Blood of Donors

Despite all blood donations being tested routinely for HBsAg as a clinical marker of transmissible HBV, cases of post-transfusion hepatitis B virus infection are still being reported because molecular studies using Polymerase Chain Reaction (PCR) are not routinely available for Transfusion Transmissible Infection (TTIs) testing. In this study, we sought to use the PCR technique to re-screen donated blood that had already been proven to be HBsAg non-reactive with rapid diagnostic testing and ELISA. One hundred and eighty-five samples were obtained from a proportion of the blood deposited at the blood bank of the Federal Medical Center, Birnin-Kebbi, Nigeria. Socio-demographic parameters such as age group, status, ethnicity, occupation, and group PCV were obtained from donors' records. Nested PCR was employed to detect HBV DNA. Furthermore, genotyping was performed to determine HBV genotypes in the positive samples using PCR with genotype-specific primers. Of the 185 donors, it was observed that five (2.7%) of the population were positive for HBV. HBV is more common among people aged 18–30, singles, Hausa, and self-employed. In addition, the five positive samples were of genotype E. This study suggests the need to complement antibody-based tests with DNA testing for effective HBV screening and consequent safe transfusion. Keywords: Hepatitis B Virus; HBsAg; PCR; DNA testing

Reactivation of occult hepatitis B virus infection in a renal transplant recipient

We report a case of hepatitis B virus (HBV) reactivation in a renal transplant recipient. Reactivation manifested as an occult infection with detectable HBV-DNA and negativity for hepatitis B surface antigen (HBsAg). The anti-HBs antibody titre was above the protective threshold and continued to rise, to 951.36 mIU/ml, after HBV reactivation. Sequencing revealed multiple vaccine- and diagnostic-escape mutations in the major hydrophilic region of HBsAg. This case demonstrates both reactivation of an HBV escape mutant in a vaccinated patient and host immunity after virus mutation.