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Occult hepatitis B
Michael Torbenson1, David L Thomas
1Department of Pathology, Division of Gastrointestinal and Hepatic Pathology, Johns Hopkins Hospital, Baltimore, MD, USA.
Insights
Occult hepatitis B, identified by sensitive DNA testing in patients negative for standard hepatitis B surface antigen, poses significant health risks. Increased awareness and testing are crucial for managing this condition, especially in co-infected individuals.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Chronic hepatitis B virus (HBV) infection is a major global cause of liver cirrhosis, hepatocellular carcinoma, and mortality.
- Traditional diagnosis relies on detecting HBV antigens and antibodies.
- A subset of chronic HBV infections, termed occult hepatitis B, is characterized by detectable HBV DNA but negative hepatitis B surface antigen (HBsAg).
Purpose of the Study:
- To review the clinical significance and diagnostic approaches for occult hepatitis B.
- To examine the specific context of occult hepatitis B in patients co-infected with hepatitis C virus (HCV).
Main Methods:
- Literature review focusing on studies identifying occult hepatitis B using molecular testing (HBV DNA).
- Analysis of clinical settings where occult hepatitis B is prevalent.
- Examination of outcomes in HBV/HCV co-infected patients with occult hepatitis B.
Main Results:
- Occult hepatitis B is detected through sensitive molecular assays for HBV DNA in HBsAg-negative individuals.
- In HBV/HCV co-infected patients, occult hepatitis B is linked to advanced liver fibrosis.
- Occult hepatitis B in co-infected patients is associated with a reduced response to interferon alpha therapy.
Conclusions:
- Occult hepatitis B represents an important, often undetected, clinical entity.
- Heightened awareness of occult hepatitis B and its diagnostic methods is medically warranted.
- Further research is necessary to fully understand and manage occult hepatitis B, particularly in co-infected populations.
Abstract:
Worldwide, chronic hepatitis B virus (HBV) infection is the primary cause of cirrhosis and hepatocellular carcinoma and is one of the ten leading causes of death. Traditionally, people with chronic HBV infection have been identified with blood tests for HBV antigens and antibodies. Recently, another group of patients with chronic HBV infection has been identified by sensitive, molecular testing for HBV DNA. Members of this group are often referred to as having occult hepatitis B because they are HBV-DNA positive, but hepatitis B surface antigen negative. Occult hepatitis B occurs in a number of clinical settings. In this review, we examine occult hepatitis B in people co-infected with hepatitis C, in whom occult hepatitis B has been associated with advanced fibrosis and diminished response to interferon alpha. Although much more research is needed, existing reports justify a heightened awareness of the medical importance and means of testing for occult hepatitis B.