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Absence of Occult Hepatitis B Virus Infection in Haemodialysis Patients in White Nile State, Sudan
Abstract
Abstract
This study was carried out to detect occult hepatitis B virus infection in haemodialysis patients in white Nile state, Sudan.
Sandwich Enzyme Linked Immunosorbent Assay (ELISA) was used to detect hepatitis B surface antigen (HBsAg),
competitive ELISA to detect Hepatitis B virus core antibody (HBcAb) and polymerase chain reaction (PCR) to detect
Hepatitis B virus (HBV) DNA were used to analyze 89 serum samples collected from patients in Abass Ibrahem
haemodialysis center in white Nile state, Sudan. Of all the patients sampled, 68 were males while 21 were females, none
of the patients showed signs of clinical hepatitis. The results showed that 1(1.1%) out of 89 samples was positive for
HBsAg and was subsequently excluded from the study. Out of the 88 HBsAg negative samples, 37(42%) (27 males and 10
females) were positive for HBcAb and 0(0%) were positive for HBV DNA with PCR.
Keywords: Hepatitis B virus (HBV); Haemodialysis; Polymerase Chain Reaction (PCR); Enzyme Linked
Immunosorbent Assay (ELISA); Sudan
... The prevalence of OBI in haemodialysis patients ranges from 0% to 51.4%, as reported in studies conducted in Egypt and Sudan [100,101] (Tables 2 and 4). Renal transplant patients have also shown a high prevalence of OBI, ranging from 18% to 51.4%, according to studies conducted by Ibrahim et al[102] and Mustafa et al[101] in Sudan. ...
BACKGROUND
Occult hepatitis B infection (OBI) is a globally prevalent infection, with its frequency being influenced by the prevalence of hepatitis B virus (HBV) infection in a particular geographic region, including Africa. OBI can be transmitted through blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma (HCC). The associated HBV genotype influences the infection.
AIM
To highlight the genetic diversity and prevalence of OBI in Africa.
METHODS
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed, Google Scholar, Science Direct, and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa.
RESULTS
The synthesis included 83 articles, revealing that the prevalence of OBI varied between countries and population groups, with the highest prevalence being 90.9% in patients with hepatitis C virus infection and 38% in blood donors, indicating an increased risk of HBV transmission through blood transfusions. Cases of OBI reactivation have been reported following chemotherapy. Genotype D is the predominant, followed by genotypes A and E.
CONCLUSION
This review highlights the prevalence of OBI in Africa, which varies across countries and population groups. The study also demonstrates that genotype D is the most prevalent.
... (1) mutations in 'α' epitope of the S gene could alter the antigenicity of HBsAg, causing the failure of anti-HBs to neutralize HBsAg; (2) or due to decline in HBV genome replication and expression; (3) also altering HBx and/or overlapping core promoter function can reduce HBV replication due to mutation in HBx ORF region [12]. ...
Background: Hepatitis B virus (HBV) remains a major public health problem worldwide that accounts for significant morbidity and mortality. About one third of the world population have serological evidence of past or present hepatitis B virus infection and more than 350 million people may be affected by chronic HBV infection. The aim of this study was to detect the prevalence of hepatitis B virus among febrile malaria and typhoid negative patients in Atbara city, River Nile State, northern Sudan. Material and methods: A total of 89 blood samples were collected from febrile malaria and typhoid negative patients including 44 females and 45 males. Sandwich Enzyme Linked Immunosorbent Assay (ELISA) was used to detect Hepatitis B Surface Antigen (HBsAg) and competitive ELISA to detect Hepatitis B Core Antibody (HBcAb) antibodies. Detection of HBV-DNA was carried out by Real time-PCR and Conventional-PCR. Results: Out of 88 samples, 44 (50%) samples were positive for HBcAb and all samples were negative for HBsAg. HBV DNA was detected in 16 (18.2%) and 1 (1.1%) of the samples using real time-PCR and conventional-PCR, respectively. Conclusion: This study had showed high prevalence of Occult Hepatitis B infection (OBI) among febrile patients in Atbara town northern State where hepatitis B infection seems to be endemic.
This study was carried out to detect occult hepatitis B virus infection in haemodialysis patients in white Nile state, Sudan.
Sandwich Enzyme Linked Immunosorbent Assay (ELISA) was used to detect hepatitis B surface antigen (HBsAg),
competitive ELISA to detect Hepatitis B virus core antibody (HBcAb) and polymerase chain reaction (PCR) to detect
Hepatitis B virus (HBV) DNA were used to analyze 89 serum samples collected from patients in Abass Ibrahem
haemodialysis center in white Nile state, Sudan. Of all the patients sampled, 68 were males while 21 were females, none
of the patients showed signs of clinical hepatitis. The results showed that 1(1.1%) out of 89 samples was positive for
HBsAg and was subsequently excluded from the study. Out of the 88 HBsAg negative samples, 37(42%) (27 males and 10
females) were positive for HBcAb and 0(0%) were positive for HBV DNA with PCR.
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 available 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.
This study was carried out to detect occult hepatitis B virus (OHB) among haemodylsis patient in Khartoum State, Sudan. Antigen capture enzyme linked immunosorbent assay (ELISA) to detect hepatitis B surface antigen (HBsAg), competitive ELISA to detect Hepatitis B core antibody (HBcAb) antibodies and polymerase chain reaction (PCR) to detect hepatitis B virus (HBV) DNA were used to analyze 100 plasma samples collected from patients in 3 hospitals (El Amel Hospital, Bashair Hospital and Salma Hospital) during the period of 2012 to 2014. Out of the patient sampled, 65 were males and 35 were females (age 18 to 70 years) none of these patients showed signs of clinical hepatitis. The results showed that 9 out of the 100 samples were positive for HBsAg, and were subsequently excluded from the study. Out of the remaining HBsAg negative 91 samples, 38(51.6%) showed positive HBc antibodies and 3 (3.3%) tested positive to HBV DNA using competitive ELISA and PCR, respectively. These results indicated that molecular detection of occult HBV infections in haemodialysis patients in Sudan is of fundamental importance to prevent HBV transmission through contamination of heamodialysis machines.
The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p = 0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p = 0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p < 0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.
Hisham Ismail1*, Mohamed Soliman2, Nahed Ismail31Department of Molecular Diagnosis, GEBR Institute, 2Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; 3Department of Pathology and Department of Microbiology and Immunology, Meharry Medical College, Nashville, Tennessee, USA *Current affiliation: College of Medicine, Qassim University, Saudi ArabiaAbstract: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are frequent in patients with end-stage renal disease who are on maintenance hemodialysis. There are limited data about the prevalence of occult HBV infection in patients on long-term hemodialysis. Occult HBV is defined as positive HBV DNA in the blood in the absence of hepatitis B surface antigen in the serum. In this study, we determined the prevalence of occult HBV in hemodialysis patients with or without HCV infection. The study included 116 patients with end-stage renal disease on chronic hemodialysis, of whom 64 patients were HCV RNA positive (Group 1), and 52 were HCV RNA negative (Group 2). We found that four of 64 (6.3%) hemodialysis patients with HCV infection (Group 1) had occult HBV, while only two of 52 (3.8%) hemodialysis patients without HCV (Group 2) had occult HBV. We then examined whether gender-matched hemodialysis patients with positive HBV DNA in the two hemodialysis groups differed in specific parameters, ie, age, degree of liver dysfunction, and presence of coinfection with schistosomiasis, a common parasitic infection of the liver. We found no significant difference between the groups having positive HBV DNA with regard to serum levels of liver enzymes, aspartate transaminase, albumin, and hepatitis B core antigen (P > 0.05). However, we detected significantly higher levels of alanine transaminase, a prolonged duration of hemodialysis, and higher levels of schistosomal antibodies in Group 1 than in Group 2. Interestingly, we found that the presence of schistosomal antibodies, history of past blood transfusion, and longer hemodialysis duration could distinguish patients with occult HBV infection from those with HBV DNA negative infection in hemodialysis patients. In conclusion, the prevalence of occult HBV in chronic hemodialysis patients is low, and does not significantly differ between hemodialysis patients with or without HCV coinfection.Keywords: occult hepatitis B virus, hepatitis C virus, schistosomiasis, hemodialysis
Occult hepatitis B virus (HBV) infection is characterized by the presence of HBV DNA in serum and/or in the liver of patients negative for hepatitis B surface antigen (HBsAg). Occult infection may impact in several different clinical contexts including the risk of HBV transmission with transfusion or transplantation, and endogenous viral reactivation. The gold standard test for detection of occult infection is the amplification of HBV DNA. However, the serological assay for the long-lasting antibody response to the highly immunogenic HBV core antigen (anti-HBc) represents a qualified candidate as a surrogate for DNA amplification, or for increasing overall sensitivity when assessing the risk of occult hepatitis in peripheral blood. The risk of occult hepatitis associated with anti-HBc seropositivity has been demonstrated extensively, and the presence of antibody response to HBc can be considered a sentinel marker of occult HBV infection.
Clin Chem Lab Med 2010;48:23–9.
Hepatitis B surface antigen is widely used in hepatitis B virus surveillance; patients who test negative for the antigen are judged to be uninfected. However, occult hepatitis B virus infection has been confirmed with hepatitis B virus DNA at low levels in the liver and peripheral blood in patients positive for hepatitis B core antibody or hepatitis B surface antibody, even if they test negative for hepatitis B surface antigen. To investigate the prevalence of occult hepatitis B virus in hemodialysis patients, we performed cross-sectional analysis of 161 hemodialysis patients in two related institutions for hepatitis B surface antigen, hepatitis B core antibody, and hepatitis B surface antibody. Hepatitis B surface antigen, hepatitis B core antibody, or hepatitis B surface antibody was present in 45 patients (28.0%). Hepatitis B virus DNA was present in six patients (3.7%), all of whom also tested positive for hepatitis B core antibody. Hepatitis B surface antibody positivity was unrelated in only one of the six patients. Four of the six patients were positive for hepatitis B surface antigen; however, two (1.3%) of these with occult hepatitis B virus infection were found to be hepatitis B surface antigen negative. Occult hepatitis B virus infection may be missed in hepatitis B virus surveillance using hepatitis B surface antigen alone; therefore, routine hepatitis B core antibody screening is necessary. Patients who test positive for hepatitis B core antibody should undergo further hepatitis B virus DNA testing to enable accurate hepatitis B virus screening.
Hepatitis B virus infection is a major public health problem worldwide; roughly 30% of the world's population show serological evidence of current or past infection. Hepatitis B virus is a partly double-stranded DNA virus with several serological markers: HBsAg and anti-HBs, HBeAg and anti-HBe, and anti-HBc IgM and IgG. It is transmitted through contact with infected blood and semen. A safe and effective vaccine has been available since 1981, and, although variable, the implementation of universal vaccination in infants has resulted in a sharp decline in prevalence. Hepatitis B virus is not cytopathic; both liver damage and viral control-and therefore clinical outcome-depend on the complex interplay between virus replication and host immune response. Overall, as much as 40% of men and 15% of women with perinatally acquired hepatitis B virus infection will die of liver cirrhosis or hepatocellular carcinoma. In addition to decreasing hepatic inflammation, long-term antiviral treatment can reverse cirrhosis and reduce hepatocellular carcinoma. Development of new therapies that can improve HBsAg clearance and virological cure is warranted.
To define the duration of viremia in the course of acute hepatitis B, we semiquantitatively determined the levels of hepatitis B virus (HBV) DNA in the sera, using polymerase chain reaction (PCR) coupled with Southern blotting, of non-immunocompromised patients with self-limited acute hepatitis B. In the sera of 10 of 11 patients, HBV DNA, which was presumably coated with viral proteins, was detected for a long period after recovery, even at the final observation times, which ranged from 6 to 19 months after disease onset. To characterize the mode of HBV that was present in serum, we immunoprecipitated immune complexes in sera by the addition of anti-human immunoglobulin G (IgG) and determined the levels of HBV DNA separately in the supernatants and pellets. In the acute phase of hepatitis B, high levels of HBV DNA were detected both in the supernatants and pellets at comparative levels. After the convalescent phase, the amount of HBV DNA in the supernatant decreased with respect to that in the pellets. It is notable that, in most cases, serum HBV persisted as a form of immune complex even after the seroconversion to antibody to hepatitis B surface antigen (anti-HBs). These data suggest that the replication of HBV may persist in some organs, most likely in the liver or peripheral blood cells, for a long period after recovery from acute hepatitis B, and the data indicate the possible transmission of HBV from organ transplantation donors who exhibit serological markers of past infection only.
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