Serological Markers Of Hepatitis B Virus Infection Research Articles

Insights into hepatitis B virus infection among pregnant women: Assessing seroprevalence, serological, and virological profile at a tertiary care hospital in India

ABSTRACT Background: India bears a considerable global burden, hosting over 37 million hepatitis B virus (HBV) carriers, primarily transmitted through the perinatal route. Therefore, this study aimed to determine the prevalence of HBV infection among pregnant women attending the antenatal clinic at a tertiary care hospital. Aims: This study sought to assess the seroprevalence of HBV infection in pregnant women, analyze the serological markers of HBV infection, and ascertain the viral load of HBV DNA. Settings and Design: The study was conducted at the Department of Microbiology and Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. It adopted a hospital-based cross-sectional design. Subjects and Methods: The study spanned from January 2021 to June 2022. HBV infection among pregnant women attending the antenatal clinic of a tertiary care hospital was identified by screening their sera using hepatitis B surface antigen (HBsAg) ELISA. For samples testing positive for HBsAg ELISA, additional tests were administered, including HBeAg, HBeAb, hepatitis B core immunoglobulin M, and total hepatitis B core antibody (immunoglobulin [Ig] M + IgG) by ELISA. In addition, a quantitative assessment of HBV DNA was conducted using real-time reverse transcription-polymerase chain reaction. Statistical Analysis Used: All data underwent coding and entry into an MS Excel spreadsheet, with analysis executed using the Statistical Package for the Social Sciences (SPSS) version 21.0. Ethical approval was obtained from the Institutional Ethics Committee, Vardhman Mahavir Medical College and Safdarjung Hospital. Informed consent was obtained from all pregnant women participating in the study. Results: Among the 1519 pregnant women screened for HBsAg, 15 tested positive, resulting in a seroprevalence of 1% (15/1519). Subsequent examination revealed two women with acute HBV/chronic hepatitis B-acute exacerbation infections (high infectivity) and 13 women with chronic HBV infections (low infectivity). Furthermore, only HBeAg-positive women exhibited HBV DNA levels surpassing 2000 IU/mL. Conclusions: The 1% seroprevalence of HBV among pregnant women implies an approximate count of 4 million infected women of reproductive age, posing a risk of vertical transmission to nearly 4 million newborns annually. With HBeAg-positive mothers, the risk of neonatal transmission ranges from 70% to 90%. Timely interventions for all pregnant women are imperative to mitigate HBV vertical transmission.

Chronic hepatitis B and occult infection in chemotherapy patients - evaluation in oncology and hemato-oncology settings: The CHOICE study.

Reactivation of hepatitis B virus (HBV) infection is a well-known risk that can occur spontaneously or following immunosuppressive therapies, including cancer chemotherapy. HBV reactivation can cause significant morbidity and even mortality, which are preventable if at-risk individuals are identified through screening and started on antiviral prophylaxis. To determine the prevalence of chronic HBV (CHB) and occult HBV infection (OBI) among oncology and hematology-oncology patients undergoing chemotherapy. In this observational study, the prevalence of CHB and OBI was assessed among patients receiving chemotherapy. Serological markers of HBV infection [hepatitis B surface antigen (HBsAg)/anti-hepatitis B core antigen (HBc)] were evaluated for all patients. HBV DNA levels were assessed in those who tested negative for HBsAg but positive for total anti-HBc. The prevalence of CHB in the study cohort was determined to be 2.3% [95% confidence interval (95%CI): 1.0-4.2]. Additionally, the prevalence of OBI among the study participants was found to be 0.8% (95%CI: 0.2-2.3). The findings of this study highlight the importance of screening for hepatitis B infection in oncology and hematology-oncology patients undergoing chemotherapy. Identifying individuals with CHB and OBI is crucial for implementing appropriate antiviral prophylaxis to prevent the reactivation of HBV infection, which can lead to increased morbidity and mortality.

Hepatitis B virus infection status and clinical characteristics in patients with rheumatoid arthritis

Objective: To investigate the epidemiology of hepatitis B virus (HBV) infection in patients with rheumatoid arthritis (RA) in China and its association with RA disease characteristics. Methods: A cross-sectional study. A retrospective study was conducted on RA patients recruited from January 2001 to February 2023 in the Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital. Demographic and clinical data were collected including age, gender, disease duration, active smoking, RA disease activity, physical function, radiographic assessment, serological markers of HBV infection and liver function indicators. According to the status of HBV infection, RA patients were grouped as chronic HBV infection, resolved HBV infection and no HBV infection groups. The distribution of each group and the clinical characteristics of RA patients were analyzed. Results: Among 1 941 RA patients, 1 461 (75.3%) completed HBV screening, including 335 males (22.9%) and 1 126 females (77.1%), with a mean age of (55.4±13.1) years. The prevalence of chronic HBV infection was 10.1%(148/1 461), which was significantly higher in male patients than in females [14.6%(49/335) vs 8.8%(99/1 126), P<0.001], especially among those males born from 1970 to 1979[20.0%(7/35) vs 8.5%(17/201), P=0.037] and 1980-1989 [31.8%(7/22) vs 10.5%(14/133), P=0.007]. Among 148 RA patients with chronic HBV infection, there were 5 cases (3.4%) of chronic hepatitis B, 2 cases (1.4%) of HBV-associated cirrhosis and 1 case (0.7%) of hepatocellular carcinoma. The prevalence of resolved HBV infection was 57.6%(841/1 461). There were 472(32.3%) patients with no HBV infection and 267(56.6%) of them showed negative anti-HBs. Among all RA patients, 15 (1.0%) patients had abnormal liver function, of which 7 cases were drug-induced liver injury, 5 cases were chronic hepatitis B, 2 cases were non-alcoholic fatty liver disease, and 1 case was primary biliary cholangitis. Conclusion: Chronic HBV infection remains a common complication in RA patients in China, the infection rate is 10.1%, and the screening and management of HBV infection should be strengthened in clinical practice.

Global prevalence of hepatitis B virus serological markers among healthcare workers: A systematic review and meta-analysis.

BACKGROUNDThe hepatitis B virus (HBV) infection is a global public health concern that affects about 2 billion people and causes 1 million people deaths yearly. HBV is a blood-borne disease and healthcare workers (HCWs) are a high-risk group because of occupational hazard to patients’ blood. Different regions of the world show a highly variable proportion of HCWs infected and/or immunized against HBV. Global data on serologic markers of HBV infection and immunization in HCWs are very important to improve strategies for HBV control.AIMTo determine the worldwide prevalence of HBV serological markers among HCWs.METHODSIn this systematic review and meta–analyses, we searched PubMed and Excerpta Medica Database (Embase) to identify studies published between 1970 and 2019 on the prevalence of HBV serological markers in HCWs worldwide. We also manually searched for references of relevant articles. Four independent investigators selected studies and included those on the prevalence of each of the HBV serological markers including hepatitis B surface antigen (HBsAg), hepatitis e antigen (HBeAg), immunoglobulin M anti-HBc, and anti-HBs. Methodological quality of eligible studies was assessed and random-effect model meta-analysis resulted in the pooled prevalence of HBV serological markers HBV infection in HCWs. Heterogeneity (I²) was assessed using the χ² test on Cochran’s Q statistic and H parameters. Heterogeneity’ sources were explored through subgroup and metaregression analyses. This study is registered with PROSPERO, number CRD42019137144.RESULTSWe reviewed 14059 references, out of which 227 studies corresponding to 448 prevalence data among HCWs (224936 HCWs recruited from 1964 to 2019 in 71 countries) were included in this meta-analysis. The pooled seroprevalences of current HBsAg, current HBeAg, and acute HBV infection among HCWs were 2.3% [95% confidence interval (CI): 1.9-2.7], 0.2% (95%CI: 0.0-1.7), and 5.3% (95%CI: 1.4-11.2), respectively. The pooled seroprevalences of total immunity against HBV and immunity acquired by natural HBV infection in HCWs were 56.6% (95%CI: 48.7-63.4) and 9.2% (95%CI: 6.8-11.8), respectively. HBV infection was more prevalent in HCWs in low-income countries, particularly in Africa. The highest immunization rates against HBV in HCWs were recorded in urban areas and in high-income countries including Europe, the Eastern Mediterranean and the Western Pacific.CONCLUSIONNew strategies are needed to improve awareness, training, screening, vaccination, post-exposure management and treatment of HBV infection in HCWs, and particularly in low-income regions.

Increased Serum Sphingosine-1-Phosphate Accompanied with Secretion of Hepatitis B Surface Antigen

Background: Chronic Hepatitis B is a major public health problem worldwide and HBsAg loss is deemed a successful response to therapy, unfortunately, rarely achieved with present treatments. The alterations of S1P production and signaling have been widely reported to promote the survival of virus and documented quite differently in various viral infections, which may be associated with hepatitis B virus (HBV) infection. However, serum S1P as the simple indicator of S1P signaling has not been well characterized in HBV infection. Methods: We detected serum S1P in 82 hepatitis B patients and 65 other virus infections, retrospectively reviewed serological markers of HBV infection, S1P transporters and storage cells in peripheral blood. In order to avoid alterations of S1P caused by liver injury, hepatic lesions of all involved patients were excluded by ultrasound examination and liver function measure. ROC curve analysis was performed to define the diagnostic efficiency of S1P in hepatitis B. Student's t test and Pearson correlation analysis were used to investigate the association between serum S1P and individual diagnostic parameters.F Findings: S1P showed significantly higher level in HBV DNA-positive hepatitis B patients (29.68±1.25μM) than that in healthy subjects(2.96±0.21μM), however, no significances were presented in other virus infection like HCV. Serum S1P was mostly correlated with HBsAg(r=0.94, P＜0.0001) and 100% rose in HBsAg-positive HBV infection. AUC of serum S1P in diagnosis of hepatitis B was 0.9995 with 95% CI of 0.9981 to 1.001, and the score of 6.99 has the 100.0% sensitivity and 98.44% specificity, with very similar diagnostic efficacy to HBsAg. Moreover, other diagnostic parameters like albumin, liver damage and liver cancer didn’t significantly alter increased serum S1P caused by HBsAg production. Interpretation: Serum S1P is the first molecule found so far to be so tightly accompanied with HBsAg released into sera, which may evoke a promised resolution of HBsAg loss by targeting S1P signaling. In addition, serum S1P would play with HBsAg as a good biomarker to monitor the activity of HBV. Funding: The National Natural Science Foundation of China and Jinjihu talent training project of Suzhou Industrial Park, Suzhou, China. Declaration of Interest: All other authors declare no competing interests. Ethical Approval: Ethical approval was granted by the Ethical Committee of hospitals involved.

Update on epidemiology of hepatitis B in a low-endemic European country: There is still much to do.

The latest epidemiological data in Spain were obtained a decade ago and revealed a prevalence of hepatitis B surface antigen (HBsAg) of 0.7%; hence, updated epidemiological data are necessary. Our aim was to determine the prevalence of hepatitis B virus (HBV) infection, and to analyse associated factors and characterize chronic infection. A population-based, cross-sectional study was performed in Spain between July 2015 and April 2017. Participants from three regions were selected using two-stage conglomerate sampling and stratified by age. Anthropometric and demographic data were collected, and blood samples were taken to detect serological markers of HBV infection and to quantify HBV-DNA. The characterization of chronic HBV infection was based on ALT (alanine aminotransferase) values, HBV-DNA levels, and results of transient elastography. The overall prevalence rates of HBsAg and antibody to hepatitis B core antigen (anti-HBc) among 12246 participants aged 20-74years (58.4% females) were 0.6% (95% CI [0.4-0.7]) and 8.2% (7.7-8.7), respectively. The risk factors for HBV infection identified in the multivariate analysis were age, nosocomial risk, and non-Spanish nationality. Moreover, most patients HBsAg positive (76.6%) presented as hepatitis B e antigen (HBeAg)-negative chronic infection (formerly 'inactive carriers') and only 6 (9.4%) HBsAg carriers fulfilled current criteria for treatment. The current HBV burden in Spain remains low but virtually unchanged over the past 15years. Increased efforts are still needed to reach the goal set forth by the World Health Organization (WHO) for HBV elimination by 2030.

Hepatitis B virus pregenomic RNA status can reveal the long-term prognoses of chronic hepatitis B patients treated with nucleos(t)ide analogues.

We examined whether the hepatitis B virus (HBV) pregenomic RNA (pgRNA) status after nucleos(t)ide (NA) treatment can predict the long-time prognoses of chronic hepatitis B patients. Patients with chronic hepatitis B (98) who were treatment-naïve and had begun a 7-year NA therapy regimen were enrolled in this study. Biochemical indicators and serological markers of HBV infection were performed during therapy. HBV pgRNA was quantified by real-time quantitative PCR with specific primers. During treatment, HBV DNA undetectable rates increased. The aminotransferase (ALT) normalization (ALT<50IU/L) and HBeAg-negative rates also increased. After 48weeks' NA treatment, 48.28% (28/58) of HBV DNA undetectable patients still had HBV pgRNA-positive. After 7years of treatment, more HBV pgRNA-negative patients (n=35) achieved HBeAg clearance than the patients who were HBV pgRNA-positive (n=63) (19/23 vs 19/56, P<.00). HBV pgRNA-positive patients also had an increased risk of failing to achieve HBeAg clearance (OR=9.25, 95% CI: 2.75-31.08). The median time to HBeAg clearance in the HBV pgRNA-positive patients was longer than that of the HBV pgRNA-negative patients (152weeks vs 72weeks). The HBV pgRNA-positive patients also required more time to achieve HBV DNA undetectable (124weeks, 95% CI: 103.33-144.67 vs 48weeks, 95% CI: 34.80-61.20). The HBV pgRNA status after NA treatment can predict the long-term prognoses of patients with chronic HBV. Patients who remain HBV pgRNA-positive after 48weeks of NA treatment have an increased risk of not achieving HBeAg clearance, need more time to achieve HBeAg clearance and undetectable HBV DNA load.

Markers of hepatitis B virus infection in a subset of young people in central Nigeria

Abstract Hepatitis B virus (HBV) is 50–100 times more infectious than HIV, and hepatitis B is endemic in Nigeria. In this study, we evaluated the serologic markers of HBV infection and associated socio-demographic factors in a subset of young people in Central Nigeria. Blood samples were collected from 350 consenting newly admitted students of the 2016/2017 academic session of Nasarawa State University, and their socio-demographic information obtained using structured questionnaires. The sera were analysed for HBsAg, HBsAb, HBcAb, HBeAg and HBeAb using a 5-panel HBV profiling diagnostic kits (Qingdad High Top Biotech Co. Ltd, Hangzhou, China). Data was analysed using Smith's Statistical Package (version 2.80, California, USA); and test of significance performed at 95% confidence limit with P values ≤0.05 considered significant. Of the 350 participants, 157 (44.9%) were male and 193 (55.1%) were female. Overall, 34 (9.7%) had HBsAg, 134 (38.3%) had HBsAb, 98 (28.0%) had HBcAb, 13 (3.7%) had HBeAg and 16 (4.6%) had HBeAb. Gender distribution showed that 20 (12.7%), 78 (49.7%), 59 (37.6%), 9 (5.7%) and 11 (7.0%) of male subjects had HBsAg, HBsAb, HBcAb, HBeAg and HBeAb respectively. Among female subjects, the distribution of HBsAg, HBsAb, HBcAb, HBeAg and HBeAb was 14 (7.3%), 56 (29.0%), 39 (20.2%), 4 (2.1%) and 5 (2.6%), respectively. Being male, unmarried and histories of alcohol consumption, blood transfusion, sharing of sharp objects and multiple sex partners were significant predictors of infection (p ˂ 0.05). This study reveals high prevalence of HBV and risk of transmission in the apparently healthy freshmen. Our findings have critical implications for intervention initiatives especially among students and youths.

Hepatitis B virus infected patients show increased risk of cerebral aneurysm rupture: A retrospective analysis

BackgroundThe mechanism responsible for cerebral aneurysm (CA) formation and rupture remains unclear. Some studies showed vascular involvement could be observed in systemic vasculitis caused by Hepatitis B. Therefore, it is necessary to determine the possibility by which hepatitis B virus (HBV) infection might be associated with CA. Methods and ResultsWe retrospectively studied patient details and serological markers of HBV infection among 229 patients presenting with CA on admission to the Neurosurgery Department at Beijing Tiantan Hospital between March 2016 and February 2017. Clinical data, radiologic findings and clinical features of HBV infection were analyzed by SPSS.The results showed a significant association between HBsAg positive (p = 0.014), anti-HBc positive (p = 0.045) and CA rupture. Univariate analysis revealed patients that were HBsAg positive (OR: 4.828; 95% CI: 1.363–17.099; p = 0.015) and anti-HBc positive (OR: 1.804; 95% CI: 1.010–3.223; p = 0.046) were associated with CA rupture. Compared with other confounding risk factors for rupture in the statistical analysis, HBsAg positive status (OR: 4.085; 95% CI: 1.011–16.513; p = 0.048) remained positively associated with CA rupture. ConclusionsObservation showed that HBsAg positivity was associated with CA rupture.

Detection of Occult Hepatitis B Virus Among Iranian HCV-Infected Patients with Hemophilia Treated with Direct-Acting Antiviral Agents

Background: One of the challenges to treat hepatitis C virus (HCV) infection is the activation of hepatitis B virus (HBV) that occurs during treatment of HCV infection with direct-acting antivirals (DAAs) in some patients. The detection of serum or liver HBV DNA in the absence of serum HBsAg (HBV surface antigen) is described as occult HBV infection (OBI). Objectives: The current study aimed at determining the prevalence of OBI in Iranian DAA-naive HCV-infected patients with hemophilia. Methods: The current study was conducted on 100 patients with hemophilia receiving DAAs. The sera obtained from these patients were tested for the presence of HBsAg. Then, the presence of the HBV DNA was detected in peripheral blood mononuclear cell (PBMC) and also plasma samples using nested polymerase chain reaction (PCR). Results: Among the 100 study subjects, 81 (81%) were male and 19 (19%) female. The mean age of the patients was 37 ± 10.50 years. All patients had previously received HBV vaccine. In the current study, HBV DNA was observed in 1% of plasma and in 3% of PBMC samples. In addition, none of the patients who had positive result for HBV detection test previously had markers of HBV infection (anti-HBc (HB core antigen) antibodies, anti-HBs antigens, and positive result of DNA PCR) and all had negative results for HCV RNA after treatment. Conclusions: Generally, the prevalence of OBI was low, but however, HBsAg negativity was not sufficient to completely exclude the presence of HBV DNA. Thus, the serological markers of HBV infection should be confirmed by molecular tests for the presence of possible occult infection.

Seroprevalence of Markers of Hepatitis B Virus Infection, Associated Factors, and Vaccination Status in Young Adults in Arkhangelsk, Northwest Russia: A Population-Based Cross-Sectional Study.

Russia had a high incidence of hepatitis B virus (HBV) infection before the vaccination campaigns of 1997, 2001, 2007, which targeted newborns, adolescents, and adults, respectively. The aim of our study was to assess the prevalence of serological markers of HBV infection, associated factors, and vaccination status among young adults in Arkhangelsk, Northwest Russia. In this cross-sectional, population-based study, we used a quota sampling method to recruit 1243 adults aged 18–39 years. Participants completed a self-administrated questionnaire and were tested for hepatitis B markers. Associations between positivity for markers and selected sociodemographic and behavioral factors were studied by logistic regression. 10.9% of our participants were positive for at least one marker of hepatitis B, 1.2% were positive for HBsAg, and 42.1% were negative for all markers. In multivariable logistic regression analyses, age 30–34 years; lack of self-reported vaccination; and having ≥2 sexual partners in the last 6 months were associated with positivity for markers of hepatitis B. Hepatitis B vaccination was confirmed in 46.9% of participants. Although half of our study sample was vaccinated, four in 10 were still susceptible to infection and more than one participant in 100 showed evidence of an active infection.

Hepatitis B Surface Antigen Seroprevalence among Prevaccine and Vaccine Era Children in Bangladesh.

.Bangladesh introduced hepatitis B vaccine in a phased manner during 2003–2005 into the routine childhood vaccination schedule. This study was designed to evaluate the impact of the introduction of hepatitis B vaccine in Bangladesh by comparing hepatitis B surface antigen (HBsAg) prevalence among children born before and after vaccine introduction and to estimate the risk of vertical transmission of chronic hepatitis B virus (HBV) infection from mother to infant. We also evaluated the field sensitivity and specificity of an HBsAg point-of-care test strip. We selected a nationally representative sample of 2,100 prevaccine era and 2,100 vaccine era children. We collected a 5-mL blood sample from each child. One drop of blood was used to perform rapid HBsAg testing. If a child had a positive HBsAg test result with the rapid test, a blood sample was collected from the mother of the HBsAg-positive child and from the mothers of two subsequently enrolled HBsAg-negative children. All samples were tested for serologic markers of HBV infection using standard enzyme-linked immunosorbent assay. One (0.05%) child in the vaccine era group and 27 (1.2%; 95% confidence interval [CI]: 0.8–1.7%) children in the prevaccine era group were HBsAg positive. Mothers of HBsAg-positive children were more likely to be HBsAg positive than mothers of HBsAg-negative children (odds ratios = 4.7; 95% CI: 1.0–21.7%). Sensitivity of the HBsAg rapid test was 91.2% (95% CI: 76.6–98.1%) and specificity was 100% (95% CI: 99.9–100%). The study results suggest that even without a birth dose, the hepatitis B vaccine program in Bangladesh was highly effective in preventing chronic HBV infection among children.

Profiles of Hepatitis B Virus Serological Markers among Asymptomatic Population in Anambra State, Southeastern Nigeria

Hepatitis B Virus (HBV) infection is apparent in endemic countries affecting millions of people. Further, the asymptomatic nature of the pathogen is a major public health concern. This study was designed to assess the burden of HBV by exploring the serologic markers of infection among consenting asymptomatic community dwellers in two cities in southeastern Nigeria.A total of 405 blood specimens were tested for HBsAg, anti-HBs, HBeAg, anti-HBe, total anti-HBc and anti-HBc-IgM using ELISA technique. Overall, 14 (3.5%) of the participants had detectable HBsAg out of which 1 (7.1%) had HBeAg and 13, anti-HBe. Two of the HBsAg positives (14.3%) had detectable anti-HBc-IgM. Atotal of 144 (35.5%) had detectable anti-HBc, even as 65 (57.0%) of them had the marker as the only serologic evidence of HBV exposure. Thirty-seven (9.1%) participants had anti-HBs only although all of them were born before the start of the childhood HBV vaccination. Altogether, 224 (57.3%) had no detectable serological markers of HBV infection or immunity and were obviously at risk of HBV infection.This study described various patterns of HBV serologic markers of infection in the study population and probable risk of virus spread. Our results support the need for urgent intervention and implementation of measures to control the spread of HBV infection in Nigeria.

Effects of amino acid substitutions in hepatitis B virus surface protein on virion secretion, antigenicity, HBsAg and viral DNA

As important virological markers, serum hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA levels show large fluctuations among chronic hepatitis B patients. The aim of this study was to reveal the potential impact and mechanisms of amino acid substitutions in small hepatitis B surface proteins (SHBs) on serum HBsAg and HBV DNA levels. Serum samples from 230 untreated chronic hepatitis B patients with genotype C HBV were analyzed in terms of HBV DNA levels, serological markers of HBV infection and SHBs sequences. In vitro functional analysis of the identified SHBs mutants was performed. Among 230 SHBs sequences, there were 39 (16.96%) sequences with no mutation detected (wild-type) and 191 (83.04%) with single or multiple mutations. SHBs consist of 226 amino acids, of which 104 (46.02%) had mutations in our study. Some mutations (e.g., sE2G, sL21S, sR24K, sT47A/K, sC69stop (sC69∗), sL95W, sL98V, and sG145R) negatively correlated with serum HBsAg levels. HBsAg and HBV DNA levels from this group of patients had a positive correlation (r=0.61, p<0.001). In vitro analysis showed that these mutations reduced extracellular HBsAg and HBV DNA levels by restricting virion secretion and antibody binding capacity. Virion secretion could be rescued for sE2G, sC69∗, and sG145R by co-expression of wild-type HBsAg. The serum HBsAg levels were lower in untreated CHB patients with novel SHBs mutations outside the major antigenic region than those without mutations. Underlying mechanisms include impairment of virion secretion and lower binding affinity to antibodies used for HBsAg measurements. The hepatitis B surface antigen (HBsAg) is a major viral protein of the hepatitis B virus (HBV) secreted into patient blood serum and its quantification value serves as an important marker for the evaluation of chronic HBV infection and antiviral response. We found a few new amino acid substitutions in HBsAg associated with lower serum HBsAg and HBV DNA levels. These different substitutions might impair virion secretion, change the ability of HBsAg to bind to antibodies, or impact HBV replication. These could all result in decreased detectable levels of serum HBsAg. The factors affecting circulating HBsAg level and HBsAg detection are varied and caution is needed when interpreting clinical significance of serum HBsAg levels. Clinical trial number: NCT01088009.

Utilization of Donors with Hepatitis B Core Antibodies in Liver Transplantation.

At present, the scarcity of organs is one of the major problems in transplantation. We present our own experience in expanding the acceptance criteria for deceased donors. We aimed to evaluate the potential impact of using hepatitis B virus (HBV) core antibody (anti-HBc)-positive donor grafts on the long-term liver transplantation results. We retrospectively analyzed data from 324 consecutive liver transplantation procedures performed in the largest transplant center in Poland, between January 2007 and February 2012. These patients included 36 who had received a liver from anti-HBc-positive donors. The presence of anti-HBc antibodies in the donor did not have a significant negative impact on the overall 3-year patient or graft survival rates. Among recipients with pre-transplant HBV infection, patients who received an organ from an anti-HBc-positive donor tended to have an improved survival rate compared with patients who received liver transplants from seronegative donors (p=0.080). However, there was a statistically significant reduction in graft survival (p=0.035) in the recipients without serological markers of HBV infection who received liver transplants harvested from anti-HBc-positive donors. These results confirm the validity of extending the acceptance criteria to anti-HBc-positive donors, particularly for patients with a prior HBV infection. Despite the increased risk of graft loss, liver transplantation from anti-HBc-positive donors among recipients not infected with HBV may also be considered in appropriate cases.

Transmission of hepatitis B virus infection among family contacts of chronic hepatitis B carriers in Sri Lanka

Introduction Hepatitis B virus (HBV) infection is a major global health problem. Incidence of HBV infection in Sri Lanka is low compared to other countries in South Asia. Horizontal transmission among close contacts is a well recognized mode of HBV transmission. A high incidence of HBV infection has been reported among family contacts of chronic HBV carriers from different parts of the world. A study was therefore designed to describe HBV serology markers among family contacts of HBV chronic carriers who were diagnosed and followed up at the Department of Virology, MRI. Methods Serological markers of HBV infection was analyzed in 230 family contacts of 78 chronic HBV carriers diagnosed and followed up at the Department of Virology, Medical Research Institute, Sri Lanka from November 2008 to December 2012. Results Among screened family members, 55 (23.9%) were positive for HB core total antibody, indicating evidence of exposure to HBV at the time of screening. Among them 14 (6.1%) were positive for HBs antigen and serological evidence of past exposure to HBV was found in 41 (17.8 %). At least one member of the family was affected in 40 (51.3%) index cases. HBV infection rate among family members (23.9%) was significant compared to the general population (1.8%) in this study. Screening of family members and vaccination of non immune members should be encouraged to prevent spreading of the infection. Health education and counseling should be given to HBV infected patients and their contacts about the disease, mode of transmission and available preventive measures.

Screening for Hepatitis B in Patients with Lymphoma

Chronic hepatitis B virus (HBV) infection can be reactivated during lymphoma chemotherapy, specifically with rituximab. In 2008, the Centers for Disease Control and Prevention and, in 2010, the American Society of Clinical Oncology made recommendations that anyone who received cytotoxic or immunosuppressive therapy should be tested for serologic markers of HBV infection. In our study, we wanted to determine the screening rates for HBV infection at our institution and if simply adding a checkbox onto the rituximab order would improve HBV screening. We performed a retrospective chart review of two cohorts of lymphoma patients at Scott & White Health Clinic. Cohort 1 included patients from 1993 to 2008. Cohort 2 included patients who received rituximab after an institutionwide protocol (rituximab order checkbox) was initiated in 2011. A total of 452 patients treated for lymphoma were reviewed. Only 15 of the 404 Cohort 1 patients received HBV screening (3.7%; 95% confidence interval, 2.1%–6.1%). Screening rates were statistically higher if baseline liver laboratory values were elevated (P < 0.0001). HBV was also checked more frequently if patients' liver function tests became elevated while on chemotherapy, 85.7% (12/14). Of the 48 patients in Cohort 2, 33 patients (68.7%) received HBV screening. No patients in either cohort had a positive HBV surface antigen or developed reactivation of HBV during chemotherapy. The addition of a checkbox on the rituximab order form significantly increased our screening for HBV infection in lymphoma patients initiating chemotherapy.

Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt.

The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p=0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p=0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p<0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.

Hepatitis B outbreak in a nursing home associated with reusable lancet devices for blood glucose monitoring, Northern Germany 2010.

In September 2010, an outbreak of acute hepatitis B virus (HBV) infections in a nursing home was notified to public health authorities in Northern Germany. To identify the route of transmission and prevent further cases a retrospective cohort study was conducted. Blood samples of residents were tested for serologic markers of HBV infection and HBV subgenotypes and sequences were analyzed. Outbreak-related cases were defined as residents of the nursing home with detection of hepatitis B surface antigen (HBsAg) and the HBV DNA sequence of the outbreak strain in 2010. Information on possible risk factors as patient care, invasive diagnostic, and therapeutical procedures was collected using a standardized questionnaire. Risk ratios (RR) and 95% confidence intervals (CI) were estimated with exact Poisson regression and binomial regression. Sixty-four residents were included in the study, 5 of them were outbreak-related cases, 12 had a past HBV infection. The outbreak strain belonged to HBV genotype D2 (HBsAg subtype ayw3, Ala118) which is not prevalent in Germany but in Eastern Europe. All cases (median age 81) were female, had diabetes, blood glucose monitoring, and chiropody. In multivariable analysis only blood glucose monitoring was associated with HBV infection (RR = 22, 95%CI 3.0-∞). Blood glucose monitoring was reported to be done by nursing home staff with patient-based reusable lancet devices. In nursing home settings the use of single use lancets for blood glucose monitoring is recommended strongly to prevent transmission. National guidelines on the handling of point-of-care devices and reusable equipment in long-term care facilities should be developed.

High prevalence of asymptomatic HBV chronic carriage in HIV infected long term survivors

Hepatitis B virus (HBV) infection is common in individuals infected with human immunodeficiency virus, and coinfection is associated with higher rates of HBV replication and more rapid liver disease progression than HBV monoinfection. This study evaluates the prevalence and virological profiles of hepatitis B infection in a cohort of long term survivors, with multiple antiretroviral treatments. 164 HIV-infected subjects (median age: 24 years) on combined antiretroviral therapy (cART) (median duration: 13 years), were evaluated for serologic markers of HBV infection (HBsAg, total anti-HBc and anti-HBsAg antibodies). Markers of HBV infectivity (HBeAg and HBV DNA) were evaluated in all HBsAg carriers; HBV genotype and lamivudine resistance mutations were analyzed in the cases with HBV DNA >103 IU/mL. 65.9% of the patients (108/164) had markers of past or present HBV infection (antiHBc positives), out of which 51.8% (56/108) were chronic HBV carriers and 30.5% had resolved HBV infection. All subjects were equally exposed to HBV infection, irrespective of their current immune status. Out of 21 patients with isolated anti-HBc antibodies, only 4 had detectable HBV DNA, presumably having occult hepatitis B. HBV chronic carriage rate was not influenced by the immune status. Overall, only 17.8% of the chronic carriers had active HBV replication; severely immune-depressed patients tend to maintain active viral replication more frequently than those with moderate or absent immunosuppression. The majority of the coinfected individuals (68.3%) showed no sign of liver fibrosis (APRI score 1.5); HBV DNA was directly correlated with APRI score. HBV genotype A was present in all but one of the tested patients. 98.8% of the coinfected subjects have been treated with a cART regimen that includes a drug dually active against HIV and HBV (in 98% of the cases lamivudine (3TC), for a mean time of 6.9 years and in 29.7% of the cases the current dually active drug was tenofovir). 3TC-resistance mutations were present in only 4 coinfected subjects. We found a strikingly low percentage of long term HIV/HBV coinfected patients from our group with active liver disease. A high prevalence of asymptomatic HBV chronic carriage was associated with a good immune status, suggesting that dually active antiretrovirals have an important role in delaying progression of liver disease in HIV/HBV coinfected patients.