Study on the Prevalence of Occult Hepatitis B Virus Infection in Patients Undergoing Hemodialysis
Occult hepatitis B (OBI) is a major challenging clinical entity characterized by the absence of hepatitis B surface antigen (HBsAg). The persistence of OBI may progress to fibrosis, cirrhosis, and hepatocellular carcinoma. This study was aimed to investigate the prevalence of OBI among HD patients. In the present cross-sectional study, 89 sera samples of hemodialysis individuals were tested for HBsAg and HBc-IgG by Enzyme-linked Immunosorbent Assay (ELISA). In addition, the HBV DNA has tested in sera and peripheral blood mononuclear cell (PBMC) samples by nested-PCR. Out of 89 patients, 51(57.3%) were males, and 38 (42.7%) females. The ages ranged from 24 to 90 years (with a mean of 57.5±1.37 years). All the sera samples had normal levels of Aspartate Aminotransferase (AST) and Alanine Transaminase (ALT) but had high levels of Creatinine (Cr) (6.9±2.17) and Blood Urea Nitrogen (BUN) (61.83±2.03). 2/89 (2.2%) sera samples were positive for both HBsAg and HBc-IgG test; in addition, HBV DNA was detected in both sera and their PBMC samples. The sera of 15/89 (16.85%) were only positive for the HBc-IgG test, including 10/51 (19.6%) males and 5/38 (13.2%) females (P=0.5). The high 16.85% prevalence OBI has been found among HD patients. To manage OBI infection, screening of HBV DNA should be implemented for HD patients by sensitive molecular means such as nested-PCR and real-time PCR.
2. Shokri S, Mahmoudvand S, Taherkhani R, Farshadpour F, Jalalian FA. Complexity on modulation of NF‐κB pathways by hepatitis B and C: A double‐edged sword in hepatocarcinogenesis. J Cell Physiol 2019;234(9):14734-14744.
3. Said ZNA. An overview of occult hepatitis B virus infection. WJG 2011;17(15):1927-1938.
4. Kim H, Lee SA, Kim DW, Lee SH, Kim BJ. Naturally occurring mutations in large surface genes related to occult infection of hepatitis B virus genotype C. PLoS One 2013;8(1):e54486.
5. Makvandi M. Update on occult hepatitis B virus infection. WJG 2016;22(39):8720.
6. Tajik Z, Bokharaei-Salim F, Ghorbani S, Keyvani H, Esghaei M, Monavari SH, Ataei-Pirkooh A, Garshasbi S, Donyavi T, Fakhim A. Detection of HBV genome in the plasma and peripheral blood mononuclear cells of Iranian HBsAg negative patients with HIV infection: occult HBV infection. Arch Virol 2018: 163(6):1559-1566.
7. Torbenson M, Thomas DL. Occult hepatitis B. Lancet Infect Dis 2002; 2(8): 479-486
8. Urbani S, Fagnoni F, Missale G, Franchini M. The role of anti-core antibody response in the detection of occult hepatitis B virus infection. Clin Chem Lab Med 2010; 48(1): 23-29
9. Ocana S, Casas ML, Buhigas I, Lledo JL. Diagnostic strategy for occult hepatitis B virus infection. WJG 2011;17(12):1553-1557.
10. Roman S. Occult Hepatitis B and Other Unexplored Risk Factors for Hepatocellular Carcinoma in Latin America. Ann Hepatol 2018; 17(4): 541-543
11. Raimondo G, Caccamo G, Filomia R, Pollicino T. Occult HBV infection. Semin Immunopathol 2013;35(1):39-52.
12. Rosenberg W. Mechanisms of immune escape in viral hepatitis. Gut 1999; 44(5): 759-764
13. Hu L-P, Liu D-P, Chen Q-Y, et al. Occult HBV infection may be transmitted through close contact and manifest as an overt infection. PLoS One 2015;10(10):e0138552.
14. Elbahrawy A, Alaboudy A, El Moghazy W, Elwassief A, Alashker A, Abdallah AM. Occult hepatitis B virus infection in Egypt. World J Hepatol 2015; 7(12): 1671-1678.
15. Elgohry I, Elbanna A, Hashad D. Occult hepatitis B virus infection in a cohort of Egyptian chronic hemodialysis patients. Clin Lab 2012;58(9-10):1057-1061.
16. Sowole L, Labbett W, Patel M, O'Riordan A, Cross J, Davenport A, Haque T. The prevalence of occult hepatitis B virus (HBV) infection in a large multi-ethnic haemodialysis cohort. BMC Nephrol 2015;6(16):12.
17. Sousa DDd, Silva CRdS, Lima Junior WP, Barros JdA, Nascimento IAdS, Souza VCd, Naveca FG, Granja F. Phylogenetic analysis and genotype distribution of Hepatitis B Virus (HBV) in Roraima, Brazil. Rev Inst Med Trop Sao Paulo 2018; 19(60):e35.
18. Rahman MA, Hakim F, Ahmed M, Ahsan CR, Nessa J, Yasmin M. Prevalence of genotypes and subtypes of hepatitis B viruses in Bangladeshi population. Springerplus 2016; 5(1): 278.
19. Allain J-P. Occult hepatitis B virus infection. Transfus Clin Biol 2004; 11(1): 18-25.
20. El Makarem MAA, Hamid MA, Aleem AA, Ali A, Shatat M, Sayed D, Deaf A, Hamdy L, Tony EA. Prevalence of occult hepatitis B virus infection in hemodialysis patients from egypt with or without hepatitis C virus infection. Hepat Mon 2012;12(4):253.
21. Ono K, Ono T, Matsumata T. The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: the role of vitamin B6 deficiency. Clin Nephrol 1995; 43(6): 405-408.
22. Crawford DR, Reyna RS, Weiner MW. Effects of in vivo and in vitro dialysis on plasma transaminase activity. Nephron 1978; 22(4-6): 418-422.
23. Ramezani A, Aghasadeghi MR, Ahmadi F, Razeghi E, Eslamifar A, Banifazl M, Sofian M, Bahramali G, Hekmat S, Aghakhani A. Isolated anti-hbc and occult HBV infection in dialysis patients. Nephrourol Mon 2015;7(1).
24. Aghakhani A, Banifazl M, Kalantar E, Eslamifar A, Ahmadi F, Razeghi E, Atabak S, Amini M, Khadem-Sadegh A, Ramezani A. Occult hepatitis B virus infection in hemodialysis patients with isolated hepatitis B core antibody: a multicenter study. Ther Apher Dial 2010;14(3):349-353.
25. Kalantari H, Ferdowsi F, Yaran M. Prevalence of occult hepatitis B virus infection in hemodialysis patients in Isfahan, Iran. Adv Biomed Res 2016;26(5):151.
26. Salehi-Vaziri M, Sadeghi F, Almasi Hashiani A, et al. Hepatitis B Virus Infection in the General Population of Iran: An Updated Systematic Review and Meta-Analysis. Hepat Mon 2016;16(4):e35577-e35577.
27. Minuk GY, Sun DF, Greenberg R, Zhang M, Hawkins K, Uhanova J, Gutkin A, Bernstein K, Giulivi A, Osiowy C. Occult hepatitis B virus infection in a North American adult hemodialysis patient population. Hepatology 2004; 40(5): 1072-1077.
28. Yakaryilmaz F, Alp Gurbuz O, Guliter S, Mert A, Songur Y, Karakan T, Keles H. Prevalence of occult hepatitis B and hepatitis C virus infections in Turkish hemodialysis patients. Ren fail 2006; 28(8): 729-735.
29. Haghshenas MR, Arabi M, Mousavi T. Hepatitis B genotypes in iran. Mater Sociomed 2014;26(2):129-133.
30. Mohebbi S, Amini-Bavil-Olyaee S, Zali N, Noorinayer B, Derakhshan F, Chiani M, Nejad MR, Antikchi M, Sabahi F, Zali M. Molecular epidemiology of hepatitis B virus in Iran. Clin Microbiol Infect 2008; 14(9): 858-866.
31. Amini‐Bavil‐Olyaee S, Alavian SM, Adeli A, Sarrami‐Forooshani R, Sabahi F, Sabouri E, Tavangar HR, Azizi M, Mahboudi F. Hepatitis B virus genotyping, core promoter, and precore/core mutations among Afghan patients infected with hepatitis B: a preliminary report. J Med Virol 2006; 78(3): 358-364.
32. Ali M, Idrees M, Ali L, Hussain A, Rehman IU, Saleem S, Afzal S, Butt S. Hepatitis B virus in Pakistan: a systematic review of prevalence, risk factors, awareness status and genotypes. Virol J 2011; 8(1): 102.
33. Abdulla IM, Goreal AA. Detection of Hepatitis-B virus Genotypes among Chronic Carriers in Duhok-Iraq. J Fac Med Baghdad 2016; 58(2): 170-175.
34. Samiei RN, Shokri S, Mahmoudvand S, Makvandi M, Shahbazian H, Shayanpur S, Nowrozi S, Nejad KH. Occult hepatitis B virus infection among hemodialysis patients. Boll Soc Ital Biol Sper 2018; 91(1).
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