HEPATITIS B is one of the most frequent post-transfusion infections. OCCULT HEPATITIS B infection (OBI) is a form of HEPATITIS B infection in which, despite the presence of HBVDNA in the serum and hepatocytes of the carrier, HBsAg is absent. In addition to the risk of transmission through the transfusion of infected blood, reactivation of HEPATITIS B in OBI patients and recipients of their blood can lead to cirrhosis, hepatic cancer, and reactivation of viral replication in the carrier. Therefore, effective assays to assess and screen for OBI in blood donors are of paramount importance and require urgent attention. Recently, several investigations in various regions of Iran have reported OBI in blood donors. In response, there has been a drive to apply more specific, sensitive, and accurate methods for the detection of HBV, which should become an obligatory screening process for all blood transfusion services. In this review, we address the progression of OCCULT HEPATITIS B and the common problems associated with OCCULT HEPATITIS B worldwide. Finally, we reflect on the research and screening that is being performed in Iran to deal with this problem.

Background: The causes of cryptogenic cirrhosis, as one of the most important unresolved issues in the management of liver failure, remains unknown. HEPATITIS B virus (HBV) infection with a high impact in Iranian liver graft recipients may have a key role in introducing and developing cryptogenic cirrhosis, especially in the OCCULT form. Therefore, the prevalence of OCCULT HBV infection was evaluated in liver transplant recipients with cryptogenic cirrhosis. Methods: In this cross-sectional study, a total of 127 liver transplant recipients with cryptogenic cirrhosis were recruited. The serum samples of patients were evaluated for immunological HBV infective markers, using enzyme-linked immune sorbent assay (ELISA) methods. Moreover, immunohistochemistry (IHC) was used for detection of HBsAg in liver tissue sections. Collected serums and liver tissue samples were also examined for HBV genomic DNA, using a qualitative polymerase chain reaction (PCR) technique. Results: HBsAg was not found in any studied liver tissue or serum samples. However, HBV genomic DNA was found in the liver tissue and serum samples of 35. 4% and 36. 2% of the liver transplant patients with cryptogenic cirrhosis, respectively. OCCULT HBV infection was found in 35. 4% of the patients with cryptogenic cirrhosis. Seropositive and seronegative types of OCCULT HBV infection were found in 82. 2% and 17. 8% of the patients, respectively. Conclusions: Findings of the high prevalence of molecular and immunological markers of HBV infection, especially OCCULT ones, in liver transplanted patients with cryptogenic cirrhosis was re-enforced. These results indicate the important role of OCCULT HBV infection in the pathogenesis of cryptogenic cirrhosis, which needs to be evaluated in the future through comprehensive studies.

Background OCCULT HEPATITIS B infection (OBI) is considered a risk factor for progression of liver disease in patients with HEPATITIS B virus (HBV) infection. This disease progression is reported to be more significant in those with concomitant HIV infection. We aimed to determine the prevalence rate of OBI in a sample of HIV-positive patients. Materials and Methods: Sixty-six HIV-infected patients with positive HEPATITIS B core antigen (HBcAb) and negative HEPATITIS B surface antigen HBsAg were included. HBV DNA was measured by real time polymerase chain reaction PCR method. Those with positive HBV viral load were considered as seropositive OBI. Then, the patients were studied regarding age, gender, intravenous drug use (IVDU), CD4 count, and concomitant infection by HEPATITIS C virus (HCV), available in their medical records. Results: Seventy-seven patients (38. 5%) had positive HBc antibody (HBcAb). Of 66 patients who were positive for both HIV and HBc antibody, eight patients (12. 12%) had OBI. About 3. 7% in age group younger than 40 years and 5. 3% in age group older than 40 years, OBI was detected. Forty-four patients (54. 5%) were male. OBI rate was 22. 2% in males and zero in females (P< 0. 05). In patients who received ART (anti-retroviral therapy) 11. 3% and in those who did not receive ART, 12. 4% had OBI. In patients with CD4 count of less than 350/mL, 20. 1% and in those with CD4 count > 350/mL, 4. 1% had OBI. In those who were IV drug user, 17. 94% and in those who were not IV drug user, 3. 57% gad OBI. Conclusion The prevalence of OBI in the studied sample of HIV-infected patients is considerable. As we did not find any significant association between OBI and studied factors except for gender, we think that screening for OBI would be useful for HIV-infected patients, especially male patients.

Purpose: This study was designed to detect OCCULT HEPATITIS B virus (HBV) infection among cornea donors to the Central Eye Bank of Iran using polymerase chain reaction (PCR).Methods: Cornea donors with negative screening serologic results for HBS Ag, HBS Ab, HCV Ab, HIV Ab, HTLV Ab, and syphilis, and positive serology for HB Core Ab, underwent real-time PCR to detect HBV DNA with a detection level of 400 IU/mL.Results: Over a 2-year period, 8372 sera from 8372 cornea donors were enrolled; 76 (0.9%) out of which were serology negative for abovementioned antibodies except for HB Core Ab. Real-time PCR performed in these 76 cases detected HBV DNA in 6 (7.9%) cases. The sera were inadequate for PCR test in 4 cases (5.3%). HBV DNA was not detectable in 66 cases (86.8%), and hence the corresponding corneas were released for transplantation.Conclusion: Nucleic acid amplification test for HBV is necessitated for detection of OCCULT HBV in cornea donors in order to minimize the risk of HBV transmission via corneal transplantation. In the present study, HBV DNA was undetectable in the majority of cases who were suspicious of OCCULT HBV infection, leading to release of the corresponding corneas for transplantation. These tissues used to be discarded because of inability to evaluate HBA DNA.

Background: Hbs-Ag positivity rates in dialysis patients correlate with endemicity in the general population. There is a subset of patients with OCCULT HBV infection that defined as the presence of detectable HBV-DNA by PCR in patients who are negative for Hbs-Ag. We decided to detect the OCCULT HBV cases in our hemodialysis patients.Methods: With support of charity society of renal patients of Qazvin, a cross sectional study was scheduled. We tested all the 134 hemodialysis patients in Buali Hospital of Qazvin university of medical sciences for viral HEPATITIS B in 1 year period. All the patients were chronic hemodialysis patients. Then Hbc-Ab and Hbs-Ag were detected by ELISA tests. Duplication is considered to have true test results. After completion of this stage, the aliquoted samples were tested for qualitative HBV-DNA (PCR). The positive cases for HBV-DNA were tested again in a referral center to ensure of test results.Results: 43% were female and 57% were male cases. We had 5 positive cases for HEPATITIS B by ELISA tests (3.7%) that 4 of them were Hbc-Ab and HBV-DNA positive also as expected, although 1 of them had negative test result by PCR test unusually. We detected 4 (3%) another positive PCR test results for HBV that had negative tests for Hbs-Ag, called OCCULT HBV cases.3 (75%) of these OCCULT cases were Hbc-Ab negative and known as seronegative OCCULT cases.No significant association was found with the duration of hemodialysis, age or sex and HCV positivity in these cases. Age of OCCULT HBV cases was significantly more (p=0.02).Conclusion: As mentioned most of our OCCULT HBV cases were seronegative. It seems that Hbc-Ab detection is not sensitive test in these cases. Segregation of positive HBV cases in hemodialysis units is mandatory and new protocols may be considered to detect the cases for segregation in the future.

Background: OCCULT HEPATITIS C virus infection (OCI) is recognized by finding HEPATITIS C virus (HCV) RNA in hepatocytes without detectable anti-HCV antibodies and viral RNA in plasma. Autoimmune HEPATITIS (AIH) is a chronic and generally progressive disease without exactly-identified etiology.Objectives: This study aimed to determine the prevalence of OCI among patients with AIH and to evaluate the tests used to rule out HCV infection in diagnosing AIH.Patients and Methods: Between July 2012 to February 2013, 35 Iranian patients with AIH who attended Tehran HEPATITIS Center were investigated. For identifying OCI, detection of HCV RNA in both ultracentrifuged serum samples and peripheral blood mononuclear cells (PBMCs) was used. Data analysis was performed using SPSS.Results: Six males and 29 females with mean disease duration of 77.1±39.5 month and mean age of 43.62±12.67 years were investigated. All cases were negative for anti-HCV antibody and we could not find any HCV RNA in ultracentrifuged serum samples and PBMCs.Conclusions: With our laboratory diagnostic method, it seems that there are no cases of OCI in patients with AIH. However, we recommend further studies with more samples and more precise laboratory method.