Prevalence of occult hepatitis B virus infection in hemodialysis patients in Isfahan, Iran

Authors
Hamid Kalantari 1
Faezeh Ferdowsi 2
Majid Yaran 3
1 Department of Gastroenterology, Isfahan Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: The absence of a detectable hepatitis B surface antigen (HBsAg) with or without hepatitis B core antibody (anti-HBc) or hepatitis B surface antibody (anti-HBs) in the presence of hepatitis B virus-DNA (HBV-DNA) is defined as occult HBV infection. This study was aimed to evaluate the prevalence of occult HBV infection in patients receiving hemodialysis (HD) in Isfahan, Iran.
Materials and Methods: This cross sectional study was done on 400 patients without acute or chronic HBV infection with end-stage renal disease undergoing regular HD. Blood samples were collected prior to the HD session, and serological markers of viral hepatitis B included HBsAg, anti-HBs and anti-HBc were measured using standard third generation commercially avail-able enzyme immunoassays kit, then samples of positive anti-HBc and negative anti-HBs were tested for HBV DNA using quantitative real-time polymerase chain reaction techniques. Data were analyzed by SPSS using t-test and Chi-square test.
Results: The mean age of patients was 51.6 ± 11.2 years. Anti-HBc positive was observed in 32 (8%) of 400 studied patients with negative HBsAg. Of 32 patients with anti-HBc positive, 15 were males and 17 were females with mean age of 49.7 ± 12.6 years. Among 32 patients with anti-HBc positive, 10 patients were negative for anti-HBs. All of 10 patients were negative for HBV DNA. The prevalence of occult HBV infection was 0%.
Conclusions: The prevalence of occult HBV infection in HBsAg negative patients undergoing HD was 0% and look to be among the lowest worldwide. So, occult HBV infection is not a significant health problem in HD patients in this region.

Keywords

1.
Elamin S, Abu-Aisha H. Prevention of hepatitis B virus and hepatitis C virus transmission in hemodialysis centers: Review of current international recommendations. Arab J Nephrol Transplant 2011;4:35-47.  Back to cited text no. 1
[PUBMED]    
2.
Johnson DW, Dent H, Yao Q, Tranaeus A, Huang CC, Han DS, et al. Frequencies of hepatitis B and C infections among haemodialysis and peritoneal dialysis patients in Asia-Pacific countries: Analysis of registry data. Nephrol Dial Transplant 2009;24:1598-603.  Back to cited text no. 2
[PUBMED]    
3.
Alavian SM, Bagheri-Lankarani K, Mahdavi-Mazdeh M, Nourozi S. Hepatitis B and C in dialysis units in Iran: Changing the epidemiology. Hemodial Int 2008;12:378-82.  Back to cited text no. 3
[PUBMED]    
4.
Fabrizi F, Messa PG, Lunghi G, Aucella F, Bisegna S, Mangano S, et al. Occult hepatitis B virus infection in dialysis patients: A multicentre survey. Aliment Pharmacol Ther 2005;21:1341-7.  Back to cited text no. 4
[PUBMED]    
5.
Wong PN, Fung TT, Mak SK, Lo KY, Tong GM, Wong Y, et al. Hepatitis B virus infection in dialysis patients. J Gastroenterol Hepatol 2005;20:1641-51.  Back to cited text no. 5
[PUBMED]    
6.
Wasley A, Kruszon-Moran D, Kuhnert W, Simard EP, Finelli L, McQuillan G, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis 2010;202:192-201.  Back to cited text no. 6
[PUBMED]    
7.
Burdick RA, Bragg-Gresham JL, Woods JD, Hedderwick SA, Kurokawa K, Combe C, et al. Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: The DOPPS. Kidney Int 2003;63:2222-9.  Back to cited text no. 7
    
8.
Hollinger FB, Habibollahi P, Daneshmand A, Alavian SM. Occult hepatitis B infection in chronic hemodialysis patients: Current concepts and strategy. Hepat Mon 2010;10:199-204.  Back to cited text no. 8
    
9.
Fang Y, Shang QL, Liu JY, Li D, Xu WZ, Teng X, et al. Prevalence of occult hepatitis B virus infection among hepatopathy patients and healthy people in China. J Infect 2009;58:383-8.  Back to cited text no. 9
[PUBMED]    
10.
Georgiadou SP, Zachou K, Liaskos C, Gabeta S, Rigopoulou EI, Dalekos GN. Occult hepatitis B virus infection in patients with autoimmune liver diseases. Liver Int 2009;29:434-42.  Back to cited text no. 10
[PUBMED]    
11.
Ramezani A, Banifazl M, Eslamifar A, Aghakhani A. Serological pattern of anti-HBc alone infers occult hepatitis B virus infection in high-risk individuals in Iran. J Infect Dev Ctries 2010;4:658-61.  Back to cited text no. 11
[PUBMED]    
12.
Shire NJ, Rouster SD, Rajicic N, Sherman KE. Occult hepatitis B in HIV-infected patients. J Acquir Immune Defic Syndr 2004;36:869-75.  Back to cited text no. 12
[PUBMED]    
13.
Tamori A, Hayashi T, Shinzaki M, Kobayashi S, Iwai S, Enomoto M, et al. Frequent detection of hepatitis B virus DNA in hepatocellular carcinoma of patients with sustained virologic response for hepatitis C virus. J Med Virol 2009;81:1009-14.  Back to cited text no. 13
[PUBMED]    
14.
Yoo JH, Hwang SG, Yang DH, Son MS, Kwon CI, Ko KH, et al. Prevalence of occult hepatitis B virus infection in hemodialysis patients. Korean J Gastroenterol 2013;61:209-14.  Back to cited text no. 14
[PUBMED]    
15.
Oesterreicher C, Hammer J, Koch U, Pfeffel F, Sunder-Plassmann G, Petermann D, et al. HBV and HCV genome in peripheral blood mononuclear cells in patients undergoing chronic hemodialysis. Kidney Int 1995;48:1967-71.  Back to cited text no. 15
[PUBMED]    
16.
Minuk GY, Sun DF, Greenberg R, Zhang M, Hawkins K, Uhanova J, et al. Occult hepatitis B virus infection in a North American adult hemodialysis patient population. Hepatology 2004;40:1072-7.  Back to cited text no. 16
[PUBMED]    
17.
Cabrerizo M, Bartolomé J, Caramelo C, Barril G, Carreno V. Molecular analysis of hepatitis B virus DNA in serum and peripheral blood mononuclear cells from hepatitis B surface antigen-negative cases. Hepatology 2000;32:116-23.  Back to cited text no. 17
    
18.
Cohen GA, Goffinet JA, Donabedian RK, Conn HO. Observations on decreased serum glutamic oxalacetic transaminase (SGOT) activity in azotemic patients. Ann Intern Med 1976;84:275-80.  Back to cited text no. 18
[PUBMED]    
19.
Jain P, Nijhawan S. Occult hepatitis C virus infection is more common than hepatitis B infection in maintenance hemodialysis patients. World J Gastroenterol 2008;14:2288-9.  Back to cited text no. 19
[PUBMED]    
20.
Di Stefano M, Volpe A, Stallone G, Tartaglia L, Prato R, Martinelli D, et al. Occult HBV infection in hemodialysis setting is marked by presence of isolated antibodies to HBcAg and HCV. J Nephrol 2009;22:381-6.  Back to cited text no. 20
[PUBMED]    
21.
Yakaryilmaz F, Gurbuz OA, Guliter S, Mert A, Songur Y, Karakan T, et al. Prevalence of occult hepatitis B and hepatitis C virus infections in Turkish hemodialysis patients. Ren Fail 2006;28:729-35.  Back to cited text no. 21
[PUBMED]    
22.
Altindiş M, Uslan I, Cetinkaya Z, Yüksel S, Ciftçi IH, Demirtürk N, et al. Investigation of hemodialysis patients in terms of the presence of occult hepatitis B. Mikrobiyol Bul 2007;41:227-33.  Back to cited text no. 22
    
23.
Aghakhani A, Banifazl M, Kalantar E, Eslamifar A, Ahmadi F, Razeghi E, et al. Occult hepatitis B virus infection in hemodialysis patients with isolated hepatitis B core antibody: A multicenter study. Ther Apher Dial 2010;14:349-53.  Back to cited text no. 23
[PUBMED]    
24.
Ramezani A, Banifazl M, Aghakhani A. Occult hepatitis B infection in chronic hemodialysis patients: Comparison of results and concepts: Occult HBV in chronic hemodialysis patients. Hepat Mon 2011;11:128-9.  Back to cited text no. 24
    
25.
Schmeltzer P, Sherman KE. Occult hepatitis B: Clinical implications and treatment decisions. Dig Dis Sci 2010;55:3328-35.  Back to cited text no. 25
[PUBMED]    
26.
Hollinger FB. Hepatitis B virus infection and transfusion medicine: Science and the occult. Transfusion 2008;48:1001-26.  Back to cited text no. 26
[PUBMED]    
27.
Zervou EK, Dalekos GN, Boumba DS, Tsianos EV. Value of anti-HBc screening of blood donors for prevention of HBV infection: Results of a 3-year prospective study in Northwestern Greece. Transfusion 2001;41:652-8.  Back to cited text no. 27
[PUBMED]    
28.
Bréchot C, Thiers V, Kremsdorf D, Nalpas B, Pol S, Paterlini-Bréchot P. Persistent hepatitis B virus infection in subjects without hepatitis B surface antigen: Clinically significant or purely “occult”? Hepatology 2001;34:194-203.  Back to cited text no. 28
    
29.
Chemin I, Trépo C. Clinical impact of occult HBV infections. J Clin Virol 2005;34:15-21.  Back to cited text no. 29
    
30.
Alavian SM, Ahmadzad-Asl M, Kabir A, Bagheri-Lankarani K. Hepatitis B virus infection in Iran: A systematic review. Hepat Mon 2008;8:281-94.  Back to cited text no. 30
    
31.
Gwak GY, Huh W, Lee DH, Min BH, Koh KC, Kim JJ, et al. Occult hepatitis B virus infection in chronic hemodialysis patients in Korea. Hepatogastroenterology 2008;55:1721-4.  Back to cited text no. 31
[PUBMED]    
32.
Jardim RN, Gonçales NS, Pereira JS, Fais VC, Gonçales Junior FL. Occult hepatitis B virus infection in immunocompromised patients. Braz J Infect Dis 2008;12:300-5.  Back to cited text no. 32
    
33.
Mina P, Georgiadou SP, Rizos C, Dalekos GN, Rigopoulou EI. Prevalence of occult hepatitis B virus infection in haemodialysis patients from central Greece. World J Gastroenterol 2010;16:225-31.  Back to cited text no. 33
[PUBMED]    
34.
Motta JS, Mello FC, Lago BV, Perez RM, Gomes SA, Figueiredo FF. Occult hepatitis B virus infection and lamivudine-resistant mutations in isolates from renal patients undergoing hemodialysis. J Gastroenterol Hepatol 2010;25:101-6.  Back to cited text no. 34
[PUBMED]    
35.
Cabrerizo M, Bartolomé J, De Sequera P, Caramelo C, Carreño V. Hepatitis B virus DNA in serum and blood cells of hepatitis B surface antigen-negative hemodialysis patients and staff. J Am Soc Nephrol 1997;8:1443-7.  Back to cited text no. 35
    
36.
Goral V, Okzul H, Tekes S, Sit D, Kadiroglu AK. Prevalence of occult HBV infection in haemodialysis patients with chronic HCV. World J Gastroenterol 2006;7:3420-4.  Back to cited text no. 36
    
37.
Ersoy O, Yilmaz R, Arici M, Turgan C, Bayraktar Y. Prevalence of occult hepatitis B infection in hemodialysis patients. Dial Transplant 2008;37:362-8.  Back to cited text no. 37
    
38.
Sav T, Gursoy S, Torun E, Sav NM, Unal A, Oymak O, et al. Occult HBV infection in continuous ambulatory peritoneal dialysis and hemodialysis patients. Ren Fail 2010;32:74-7.  Back to cited text no. 38
[PUBMED]    
39.
Abu El Makarem MA, Abdel Hamid M, Abdel Aleem A, Ali A, Shatat M, Sayed D, et al. Prevalence of occult hepatitis B virus infection in hemodialysis patients from egypt with or without hepatitis C virus infection. Hepat Mon 2012;12:253-8.  Back to cited text no. 39
[PUBMED]    
40.
Albuquerque AC, Coelho MR, Lemos MF, Moreira RC. Occult hepatitis B virus infection in hemodialysis patients in Recife, State of Pernambuco, Brazil. Rev Soc Bras Med Trop 2012;45:558-62.  Back to cited text no. 40
[PUBMED]    
41.
Pondé RA, Cardoso DD, Ferro MO. The underlying mechanisms for the 'anti-HBc alone' serological profile. Arch Virol 2010;155:149-58.  Back to cited text no. 41
    
42.
Grob P, Jilg W, Bornhak H, Gerken G, Gerlich W, Günther S, et al. Serological pattern “anti-HBc alone”: Report on a workshop. J Med Virol 2000;62:450-5.  Back to cited text no. 42
Advanced Biomedical Research
Volume 2016, september
September 2016
Pages 1-5