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Are current screening protocols for chronic hepatitis B virus infection adequate?
Eva Mortensen1, Amanda Kamali1, Patricia L Schirmer2
1VA Palo Alto Health Care System, Palo Alto, CA, USA; Stanford University, Stanford, CA, USA.
Diagnostic Microbiology and Infectious Disease
|March 25, 2016
Summary
Occult hepatitis B infection (OBI) is often missed by standard HBsAg screening. Comprehensive testing including anti-HBc and HBV DNA is crucial for accurate diagnosis and preventing transmission.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Standard hepatitis B virus (HBV) screening relies on HBsAg testing.
- Antibody assays (anti-HBc, anti-HBs) indicating resolved infection or immunity are not routinely performed.
- Occult HBV infection (OBI), detectable by HBV DNA in HBsAg-negative individuals, remains a diagnostic challenge.
Purpose of the Study:
- To evaluate the prevalence of OBI in a veteran population.
- To assess the inadequacy of HBsAg testing alone for HBV detection.
- To highlight the implications of OBI for public health and patient management.
Main Methods:
- Screening of patient blood samples using HBsAg, anti-HBc, and anti-HBs immunoassays.
- HBV DNA testing for anti-HBc positive samples.
- Literature review to determine OBI prevalence in published studies.
Main Results:
- OBI was detected in 2.2% of anti-HBc positive individuals in the cohort.
- A literature review indicated OBI prevalence as high as 10% in specific populations.
- HBsAg testing alone was insufficient to identify all HBV infections.
Conclusions:
- Occult HBV infection is more prevalent than previously thought.
- Current HBV screening protocols are inadequate for detecting all infections.
- Findings impact blood donation, patient screening, and management of immunosuppressed individuals.
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