Control of occult hepatitis B virus infection

Marta Lalana Garcés; Oihana Ortiz Pastor; Gemma Solé Enrech; Armando R Guerra-Ruiz; Gregori Casals Mercadal; Alejandro Almería Lafuente; María Antonieta Ballesteros Vizoso; Pablo Gabriel Medina; Sergio Salgüero Fernández; Angielys Zamora Trillo; Isabel Aured de la Serna; Juan Carlos Hurtado; Sofía Pérez-Del-Pulgar; Xavier Forns; Manuel Morales Ruiz

doi:10.1515/almed-2022-0065

Control of occult hepatitis B virus infection

Adv Lab Med. 2022 Aug 15;3(4):321-341. doi: 10.1515/almed-2022-0065. eCollection 2022 Dec.

[Article in English, Spanish]

Authors

Marta Lalana Garcés^{1

2}, Oihana Ortiz Pastor^{1

3}, Gemma Solé Enrech^{1

4}, Armando R Guerra-Ruiz^{1

5}, Gregori Casals Mercadal^{1

6}, Alejandro Almería Lafuente^{1

7}, María Antonieta Ballesteros Vizoso^{1

8}, Pablo Gabriel Medina^{1

9}, Sergio Salgüero Fernández^{1

10}, Angielys Zamora Trillo^{1

11}, Isabel Aured de la Serna¹², Juan Carlos Hurtado^{13

14}, Sofía Pérez-Del-Pulgar¹⁵, Xavier Forns¹⁵, Manuel Morales Ruiz^{1

6

16}

Affiliations

¹ Comisión de Valoración Bioquímica de la Enfermedad Hepática, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain.
² Servicio de Análisis Clínicos, Hospital de Barbastro, Huesca, Spain.
³ Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, Spain.
⁴ Servei de laboratori, UDIAT-CD, Corporació Sanitaria Parc Taulí, Sabadell, Spain.
⁵ Servicio de Análisis Clínicos, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
⁶ Servicio de Bioquímica y Genética Molecular, CDB, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
⁷ Servicio de Bioquímica Clínica, Hospital Royo Villanova, Zaragoza, Spain.
⁸ Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
⁹ Servicio de Bioquímica Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁰ Servicio de Análisis Clínicos, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
¹¹ Servicio de Bioquímica Clínica, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
¹² Servicio de Digestivo, Hospital de Barbastro, Huesca, Spain.
¹³ Servicio de Microbiología, CDB, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
¹⁴ Instituto de Salud Global de Barcelona (ISGlobal), Barcelona, Spain.
¹⁵ Servicio de Hepatología, Hospital Clínic de Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
¹⁶ Departamento de Biomedicina de la Facultad de Medicina y Ciencias de la Salud-Universidad de Barcelona, Barcelona, Spain.

Abstract

Background: The diagnosis of hepatitis B virus (HBV) infection requires HBV DNA testing and serologic testing for detection of the surface antigen (HBsAg) and the hepatitis B core antibody (anti-HBc). There is a population of patients with occult HBV infection (OBI), which is not detected by HBsAg or HBV DNA quantification in blood, despite the presence of active replication in the liver.

Scope: This document provides a definition of OBI and describes the diagnostic techniques currently used. It also addresses the detection of patients with risk factors and the need for screening for OBI in these patients.

Summary: Correct diagnosis of OBI prevents HBV reactivation and transmission. Diagnosis of OBI is based on the detection of HBV DNA in patients with undetectable HBsAg in blood.

Perspectives: A high number of patients with OBI may remain undiagnosed; therefore, screening for OBI in patients with factor risks is essential. For a correct diagnosis of OBI, it is necessary that new markers such as ultrasensitive HBsAg are incorporated, and a more comprehensive marker study is performed by including markers such as cccDNA.

Keywords: covalently closed circular DNA (cccDNA); occult HBV infection (OBI); ultra-sensitive hepatitis B virus surface antigen (ultra-sensitive HBsAg).