Context: Various frequency rates of OCCULT HEPATITIS B virus infection (OBI) are reported from different parts of Iran. This systematic review and meta-analysis aimed to characterize the OBI epidemiology in Iran and estimate the pooled prevalence among different populations. Evidence Acquisition: Nine internationalandPersian electronic databases, as well assomeconference proceedings, were searched. Original cross-sectional studies up to December 2018 were included if they investigated the prevalence of OBI by the detection of serum HEPATITIS B virus surface antigen and HEPATITIS B virus nucleic acid in at least 30 samples selected with any sampling methods. Comprehensive meta-analysis software was used to analyze the data, and Cochran’ s Q-test and I-square statistics were applied to assess the heterogeneity. Meta-regression analysis was performed to assess the impact of the year of study on the OBI frequency. A P value < 0. 05 was considered as the level of significance. Results: Of 412 citations found in electronic sources and 35 relevant citations added by searching the gray literature, 83 nonduplicated non-overlapping studies were evaluated. A total of 55 documents comprising 14, 485 individuals from 16 provinces met the inclusion criteria and were used in the analysis. The prevalence of OBI considerably varied in different parts of the country with the highest prevalence (63. 1%) reportedamongthe HIV-positive population in Fars province. The rates of the OBI prevalencewereestimatedat 0. 06% (95% CI: 0. 02-0. 16%)amongblood donors (BDs) regardless of their anti-HBc status, 7. 90% (95% CI: 4. 33-13. 99%)among anti-HBc positive BDs, 2. 49% (95% CI: 1. 2-4. 81%) among hemodialysis (HD) patients, 4. 44% (95% CI: 1. 56-12. 02%) among HIV-positive patients, and 7. 76% (95% CI: 4. 57-12. 86%) among HCV-positive patients. No significant trends were observed in OBI prevalence rates among different groups over time (P > 0. 05). Conclusions: This review revealed high rates of OBI prevalence among high-risk populations in Iran. It is strongly suggested that OCCULT HEPATITIS B be investigated among populations with a high chance of its occurrence in our country.

In the recent issue of Middle East Journal of Digestive Diseases, we read with great interest the article by Bahari et al. 1, “Significance of response to hepatitits B vaccine in subjects with isolated antibody to HEPATITIS B core antigen”.We wanted to specify some important matters related to the article.Initially, definition of OCCULT HEPATITIS B virus infection is the existence of HEPATITIS B virus (HBV) deoxyribonucleic acid (DNA) in the liver of individuals negative for HEPATITIS B surface antigen (HBsAg) by currently available assays.2Serum HBV DNA titres may be detectable (usually very low, <200 IU/ml) or undetectable, and may show fluctuation in OCCULT HEPATITIS B virus infection patients. Also, OCCULT HEPATITIS B virus infection may occur not only seropositive for antibodies to HEPATITIS B core antigen (anti-HBc) and/or antibodies to HBsAg (anti-HBs), but also seronegative.

Background and Objectives: Despite the increased sensitivity of screening tests, the HBV can be transmitted during the window period and OCCULT HEPATITIS B infection. The purpose of this study was to evaluate HBV markers and prevalence of OBI among HBsAg negative blood donors in Golestan province. Materials and Methods: Anti-HBc (IgM and IgG), anti-HBs and anti-HBe tests on 4313 serum samples (HBsAg negative) were performed by ELISA method. Also, all samples for the presence of HBV-DNA were tested by using NAT methods. SPSS software and chi-square test were used for data analysis. Results: Of the 4313 samples, 384 (8. 9%) sera were anti-HBc positive. Also, of 384 anti-HBc positive samples, 302 (78. 65%) were anti-HBs positive and 152 (39. 6%) were anti-HBe positive. Thirty-nine (0. 90%) samples were anti-HBc positive, an-ti-HBs negative and anti-HBe negative. HBV-DNA was not detected in any of specimens. Conclusion: Based on the results of retesting the isolated anti-HBc samples that after one year recalling, had undetectable HBV-DNA and for the prevention of the decreasing of healthy blood donation (due to false positive anti-HBc) and pres-ervation of the blood supplies,Individual Donor Nucleic Acid Testing (ID-NAT) along with the anti-HBc testing for the improving blood safety is recommended.

Patients with chronic HEPATITIS B infection should be followed up to identify possible chang­es in disease status, such as HBsAg seronversion. There are little data on the outcome of such cases, and the response rate to HBV vaccine has not been discussed extensively.

Background: OCCULT HEPATITIS B virus (HBV) infection (OBI) is a form of the disease which does not present with HEPATITIS B surface antigens (HBsAg) in the serum of patients with HBV DNA being detectable in the serum and hepatocytes. OBI is an important risk factor for acquiring post transfusion HEPATITIS. This could lead to reactivation of the HBV, liver cirrhosis, and hepatocellular carcinoma. We aimed to examine the prevalence of OBI in frequent blood and blood product transfused Egyptian pediatric patients. Materials and Methods: This case-control study was done in pediatric department, Minia University. Forty-five patients randomly selected from the blood transfusion unit in the central Minia blood bank were enrolled. Their age ranged from 3-18 years. Another 12 known HEPATITIS B positive age-and sex-matched patients were enrolled as controls. Routine AST, ALT, blood urea, serum creatinine, and hemoglobin levels were done, HBsAg, anti-HEPATITIS B surface antibodies (anti-HBsAb), anti-HEPATITIS B core antibodies (anti-HBcAb), and HBV DNA (by nested PCR) were examined for both patients and controls. Results: Although anti-HBs serum levels were ≥ 10IU/L, HBV DNA was present in 27 (60%) of the 45 HBsAg negative patients. Thirteen (48%) of the OBI patients were anti-HBcAb positive. No significant differences were found between HbcAb positive and negative OBI groups regarding age, gender, frequency of blood transfusion, presence of hepatomegaly, presence of splenomegaly, serum ferritin, AST, ALT, blood urea, serum creatinine, and hemoglobin levels. On the other hand, HEPATITIS C Virus Ab positivity was significantly higher among HbcAb positive patients (p=0. 02). Conclusion: Based on the results, the risk of acquiring OBI is high in patients receiving frequent blood transfusions despite obligatory HBV vaccination.

Background: The SEN virus (SENV) is a prevalent blood borne pathogen that has a worldwide incidence. SENV is comprised of eight genotypes; genotypesHandDare frequently associatedwith the pathogenesis of non-A-E HEPATITISandpost-transfusion HEPATITIS in blood donors and HEPATITIS patients. So far, no SENV pathogenesis has been reported in the liver biopsies of SENV carriers, but the frequency of SENV and its related genotypes requires further molecular epidemiology studies in different regions of the world. OCCULT HEPATITIS B infection (OBI) is another global public health problem that is primarily transmitted via blood transfusions. Therefore, the identification of OBI among blood donors is key to preventing the spread of this disease. The relationship between SENV and OBI requires further evaluation. Objectives: The aim of this study was to determine the prevalence of SENV-D and SENV-H in blood donors in Ahvaz city with a particular focus on co-infection with OBI. Patients and Methods: This study had a cross-sectional design and included 184 healthy consecutive blood donors who visited a blood transfusion center in Ahvaz city from October-November 2013. The sera of all blood donors negative for HBsAg, anti-HCV antibody, and anti-HIV antibody were tested for SENV-D and SENV-H using nested polymerase chain reaction (PCR). In addition, tests for HBV DNA (PCR), HBcIgG (ELISA), liver function (aspartate transaminase and alanine transaminase), and alkaline phosphatase were carried out. Results: Liver function tests in the healthy blood donors were within the normal range. The incidence rates of SENV-D and SENVH in the 184 total blood donors were 10 (5. 4%) (95% confidence interval (CI): 2. 1%-9. 0%) and 32 (17. 4%) cases (95% CI: 12. 0%-23. 0%), respectively. SENV-H/D co-infection occurred in 2 (1. 1%) patients. The sera of 8/184 (4. 3%) were positive for anti-HBc antibody but negative for HBV DNA. Conclusions: Regardless of the presence of nonpathogenic SENV, 44/184 (24%) blood donors tested positive for both SENV-D and SENV-H. Although 4. 3% of blood donors were positive for HBcIgG but negative for HBV DNA, the presence of OBI cannot be ruled out unless their liver biopsies show negative for HBV DNA.

Background and objective: OCCULT HEPATITIS B virus (HBV) infection is characterized by presence of HBV infection with undetectable HEPATITIS B surface antigen (HBsAg). Surface gene mutants have been reported in a variety of patient groups. Due to limited data regarding these mutations in patients with OCCULT HBV infections; we aimed to determine the surface gene mutations of HBV among high risk patients with OCCULT HBV infection.Materials and methods: 395 patients including 289 patients on chronic hemodialysis and 106 HIV infected subjects were enrolled. HBsAg, anti-HBs, anti-HBc and anti-HCV were tested in all subjects. The presence of HBV-DNA was determined in plasma samples of patients with isolated anti-HBc by real-time PCR. In HBV-DNA positive patients, surface gene region was amplified by nested PCR and surface gene mutations were analyzed after direct sequencing.Results: Insertion of a T residue at position 60 and a G residue at position 89 were seen in two isolates which made their HBs proteins nonfunctional and premature stop codons were observed in 2 other isolates via replacing of T by A at position 44 and G by T at position 28 respectively.Amino acid substitution at amino acid position 207 (S207N) was found in the other isolates.Conclusion: Our study suggested that the "a" region mutations did not playa major role in HBsAg detection and other mutations may be responsible for the existence of OCCULT HBV infection and failure to detect HBsAg by routine laboratory tests.