Diagnosis and Management of Occult Hepatitis B Infection
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HEPATITIS B (JK LIM, SECTION EDITOR)
Diagnosis and Management of Occult Hepatitis B Infection Brian T. Lee 1 & Ponni V. Perumalswami 1 Accepted: 16 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Occult hepatitis B infection refers to the presence of replication-competent hepatitis B virus despite the lack of hepatitis B surface antigen due to epigenetic or immune control. Risk factors for occult hepatitis B infection include sex work, blood transfusion, hemodialysis, and liver transplantation. Historically, the recognition of occult hepatitis B infection has been important in preventing reactivation of hepatitis B infection and mortality in those receiving treatment for HIV and hepatitis C virus along with those receiving immunosuppressive therapy. Recent Findings Recognition of occult hepatitis B infection has increased and continues to evolve with improved detection methods in both serum and liver tissue to identify HBV DNA. Advancements in the understanding of genetic variations of hepatitis B have also contributed to the differentiation of overt versus occult hepatitis B infection. More recent research has contributed to the debate that occult hepatitis B infection may play a role in clinical outcomes such as chronic liver disease and hepatocellular carcinoma. Summary With enhanced awareness of occult hepatitis B and improved methods for detection of HBV DNA and hepatitis B surface antigen, future studies understanding the natural history will shape policy regarding therapeutics and preventive strategies to prevent occult hepatitis B–related morbidity and mortality. Keywords Occult hepatitis B virus infection
Introduction Occult hepatitis B virus (HBV) infection (OBI) is defined by the presence of replication-competent HBV DNA in the liver and/or blood despite a negative hepatitis B surface antigen (HBsAg) by currently available assays [1••]. OBI prevalence has been difficult to estimate due to a lack of standardized testing and variation in sensitivity of assays, populations studied, and the number of blood samples tested over time. Despite these limitations, OBI appears to be most prevalent in developing countries, especially in areas where hepatitis B is endemic [1••]. Recently, it has been demonstrated that the global impact of OBI is increasing due to the prevalence of OBI in immigrants in developed countries [2]. This article is part of the Topical Collection on Hepatitis B * Ponni V. Perumalswami [email protected] 1
Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, Recanati/Miller Transplantation Institute, One Gustave Levy Place Box 1123, 1425 Madison Avenue Room 11-70, New York, NY 10029, USA
As evolving research has improved detection and increased awareness of its potential role in clinical outcomes, the significant effect of OBI must be acknowledged in the development of healthcare policy at both preventive and therapeutic levels. International experts have convened in Taormina, Italy, most recently
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