BACKGROUND AND OBJECTIVE: Immune system is unable to complete clearance of HEPATITIS B virus in OCCULT HEPATITIS B infection (OBI). Some of immune response is defect against HEPATITIS B virus in these patients. Scientists believed the involvement of genetic and immunological factors in etiology of OBI. Due to the regulatory impact of vitamin D3 on immune system, study of vitamin D receptor (VDR) polymorphisms aid to better understanding of disease. Therefore, in this study we examined exon 9 polymorphisms of VDR in OBI patients.METHODS: In this experimental study, 3700 samples were examined for anti-HBc and HBsAg by ELISA. The HBsAg negative and anti-HBc positive samples were screened for HBV-DNA by PCR. OBI patients (57 cases) (HBsAg negative and anti-HBc positive, HBV-DNA positive) and 100 healthy controls (HBsAg negative and anti-HBc positive, HBV-DNA negative) were analyzed for exon 9 polymorphisms of VDR by PCR-RFLP techniques.FINDINGS: Our findings demonstrated that 57 cases had OBI among 3700 studied cases. Polymorphisms analysis showed that 3.5% (2 cases) of OBI patients and 18% (18 cases) of controls had T/T alleles in this region which the difference was statistically significant in patients and controls (p<0.049). There was not also a significant difference between OBI patients and controls regarding T/t and t/t alleles of this region of VDR. CONCLUSION: Regarding results of this study we can be concluded that the T/T allele in exon 9 of VDR may play key role in ability of immune system in clearance of HBV in OBI patients.

Introduction: OCCULT HEPATITIS B virus (HBV) is defined by the presence of HBV DNA in patient sera in the absence of HBsAg. OCCULT HBV has been associated with hepatocellular carcinoma, reactivation during immune suppression, and transmission to others. While the HEPATITIS B vaccine is very effective at preventing chronic HBV infection, recent studies indicate it is less effective at preventing OCCULT HBV following infant vaccination. No studies, however, have examined the efficacy of adult HBV vaccination at preventing OCCULT HBV. Here, we present the first report of OCCULT HBV following adult vaccination.Case Presentation: A 21-year old Caucasian female presented with tricuspid valve endocarditis secondary to methicillin-susceptible Staphylococcus aureus with non-ischemic cardiomyopathy. She reported active use of intravenous drugs. Her liver enzymes were elevated (ALT=1873 IU/mL; AST=4518 IU/mL), and she was found to have HCV and OCCULT HBV. HBV viral loads ranged from 4608 - 8364 copies IU/mL during hospitalization. The patient’s HBV was sequenced and found to be genotype D3 without any known diagnostic escape mutations. Immune complexes that may have prevented HBsAg detection were not observed.Conclusions: HBV vaccination in infancy is effective at preventing chronic HBV infection but is less effective at preventing OCCULT HBV infection. Similar studies examining the efficacy of adult HBV vaccination in preventing OCCULT HBV have not been performed. This case highlights the importance of carefully determining the HBV status of high-risk individuals, as vaccination history and the presence of anti-HBs may not be adequate to rule out HBV infection, even in the absence of HBsAg.

Background: In patients who are HEPATITIS B virus (HBV) DNA-positive, but HBV surface antigen (HBsAg) -negative, the infection is referred to as OCCULT HEPATITIS B infection (OBI). OCCULT HBV infection is harmful when other liver diseases are present, and can aggravate liver damage in in patients with chronic liver diseases. In human immunodeficiency virus (HIV) infection the suppression of viral replication by the immune system might be inactivated, and classical HBV infection in OBI patients may occur.Health care professionals should be aware of OBI in HIV patients. The routine test for HBV infection in Iran is the enzyme-linked immunosorbent assay for the HBV surface antigen (ELISA HBsAg); therefore, the aim of this study was to evaluate the prevalence of OBI in Iranian HIV patients.Methods: This cross-sectional study was conducted in 2012 on sera from all the known and accessible HIV patients in Jahrom and Fassa, two cities in southern Iran. All samples were tested for the HBsAg, HBV core antibody (HBcAb). All the results were analyzed using SPSS.Results: Of the 91 patients, seven (7.7%) were HBsAg-positive and forty-five (49.5%) were HBcAb-positive. In patients with negative HBsAg (84 patients), 39 (46.4%) were HBcAb positive and 53 (63%) were positive for HBV DNA.Conclusion: The prevalence of HBV infection is relatively high in HIV patients, and more accurate tests than those presently in use should be used for diagnosis.

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.

Background: OCCULT HEPATITIS B infection (OBI) is a form of viral HEPATITIS in which the HBVDNA is present in blood while the HBsAg is undetectable. As differences in genetics and immunological responses have important role on OBI we were persuaded to analyze the known CCR5-D32 mutation (a chemokine receptor) in patients with OBI.Materials and Methods: In this descriptive study, 3700 blood samples that were HBsAg negative were collected during March 2006 to February 2007, from Rafsanjan blood transfusion services. All samples were tested for anti-HBc antibody. The HBsAg negative and anti-HBc positive samples were analyzed for HBV-DNA by PCR technique. The HBV-DNA positive samples were regarded as OBI cases. Finally, the Gap-PCR was performed to examine the d32 mutation in OBI patients. Results: The analysis of results showed that 352 (9.51%) cases of HBsAg negative samples were positive for anti-HBc. Following examination of HBsAg negative and anti-HBc positive samples for HBV-DNA by PCR based methods; we found that 57(16.1%) cases had HBV-DNA. None of the OBI patients had d32 mutation in CCR5 chemokine receptor whereas 2(2%) of controls had heterozigotic form of this mutation.Conclusion: Based on the results of this study it seems that CCR5-D32 mutation does not affect the immune response against HBV to make OBI.

Background and objectives: HEPATITIS B virus infection is a major health problem in worldwide. The prevalence of OCCULT and chronic HBV in hemodialysis patients is higher than standard in developing countries. People with OCCULT HBV are negative for HBV surface antigen (HBsAg) but positive for HBV-DNA. We aimed to evaluate OCCULT HEPATITIS B infection in patients under hemodialysis in Panje-Azar hospital in Gorgan.Material and Methods: In this study, taken place from 2009 to 2010, the participants were 100 hemodialysis patients with administration of complete HBV vaccination with negative test for HBsAg. After preparing 10 milliliter blood sample, HBV DNA testing was performed by polymerase chain reaction (PCR).Result: The mean age of the patients is 54.60 years. They are male (48%) and female (52%). They have been under hemodialysis for 48 months, averagely.There has not been any HBV-DNA in HBsAg negative patients under hemodialysis. The rate of OCCULT HEPATITIS B infection in these end stage renal disease (ESRD) patients was zero.Conclusion: Results indicate that there is no any OCCULT HBV infection in ESRD patients under hemodialysis in Gorgan, which is similar to some studies. The results could be justified by complete vaccination of the patients.

OCCULT HEPATITIS B virus infection (OBI) is one of the most challenging entities in the field of viral HEPATITIS. The virological and clinical relevance of OBI in patients treated with novel direct-acting antivirals (DAA) for HEPATITISCvirus (HCV) infections is currently a topic of hot debate. In cases where HEPATITIS B surface antigen (HBsAg) is not detected, DAA treatment is often initiated without examining for the presence of HEPATITIS B virus (HBV) DNA. In this study, the incidence of OBI was investigated in 114 HCV patients prior to application of DAAswhodid not respond to pegylated interferon and ribavirin (PEG-INF and RBV) treatment. Serum samples were screened for HBV serological markers (antibody to HEPATITIS B core antigen [anti-HBc] and HBsAg). Samples positive for anti-HBc without HBsAg were further examined via real-time PCR (qPCR), nested PCR and S-gene mutational analyses. Overall, anti-HBc was detected in 37. 7% chronic HCV patients and 2. 6% had OBI with a baseline HBV DNA viral load < 2000 IU/mL before DAA therapy. Onepatient was identified asHBVgenotype A1 without mutations in surface protein. Our collective data highlight the importance of clinicians being aware of potential anti-HBc positivity in patients with HEPATITIS C and the issues surrounding OBI screening before initiation of treatment with novel DAAs.