Transmission routs of both HEPATITIS B and HEPATITIS C viruses are similar and infection with both viruses is common. OCCULT HEPATITIS B is a new entity in which serum HBsAg is negative but HBVDNA is detectable in serum or liver tissues. In this study the frequency of OCCULT HEPATITIS B among patients with chronic HEPATITIS C and also their biochemical and histological changes were investigated. In this study, 27 patients with chronic HEPATITIS C with negative serum HBsAg were enrolled. These patients had been referred to Taleghani hospital and RCGLD (Research Center for Gastroenterology and Liver Diseases) or THC (Tehran HEPATITIS Center) during years 2001 and 2002 and had been undertaken liver biopsy. Liver biopsies were reviewed and HEPATITIS B virus (HBV) DNA and HBsAg and HBcAg were assayed in liver tissue by polymerase chain reaction (PCR) and immunohistochemistry (IHC) respectively. From 27 chronic HEPATITIS C patients studied, HBVDNA was detectable by PCR in 5(19%). Immunohistochemistry for both HBcAg and HBsAg were reported to be negative in all patients. Histological changes of cirrhosis and symptoms of decompensated cirrhosis were seen just in HBVDNA positive patients. This study concludes that OCCULT HBV infection is common among chronic HEPATITIS C patients. OCCULT HEPATITIS B probably accelerates the evolution to cirrhosis in patients with chronic HEPATITIS C.

Background: Exposure to HEPATITIS B virus (HBV) or human immunodeficiency virus (HIV) infection is common among HEPATITIS C virus (HCV)-infected Intra venous drug users (IVDUs); however there exist only a few data about frequency and risk factors of HCV, OCCULT HBV infection (OBI) and HIV among IVDUs. Objectives: This study aimed to investigate the prevalence and associated risk factors for OBI and HIV infectionsamongIranianHCV infected IVDUs. Methods: Serum samples were screened for the presence of HEPATITIS C virus antibody (HCVAb), HEPATITIS B core antibody (HBcAb), HEPATITIS B surface antigen (HBsAg), and human immunodeficiency virus antibody/antigen (HIVAb/Ag) using enzyme linked immunosorbent assay (ELISA). For detection of OBI, presence of HBV DNA among HBcAb positive/HBsAg negative subjects was determined using nested polymerase chain reaction (PCR). Results: Among all subjects, 94 cases (53. 5%) were positive for HCVAb from which 7% and 23. 4% were positive for HCV/OBI and HCV/HIV co-infections, respectively. Asignificant association existed betweenHCVAbwith type of drug, sharing syringes and needles and a history of imprisonment. In the case of HCV/OBI co-infections, the only significant correlation was between sharing a syringe and OCCULT HEPATITIS B infection. Also no significant association existed between risk factors and HCV/HIV co-infections. Conclusions: the present data documented an alarming prevalence of HCV and HIV as well as co-infections among IVDUs, which emphasizes the requirement for expansion of public health interventions for this at-risk population. Despite previously high prevalence reported for HCV/HBV/HIV triple infections among IVDUs, low prevalence of triple HCV/OBI/HIV infections was obtained. The reason for this difference may be related to the effect of HCV on HBV expression in case of OBI which had been suggested previously.

Background: One of the challenges to treat HEPATITIS C virus (HCV) infection is the activation of HEPATITIS B virus (HBV) that occurs during treatment of HCV infection with direct-acting antivirals (DAAs) in some patients. The detection of serum or liver HBV DNA in the absence of serum HBsAg (HBV surface antigen) is described as OCCULT HBV infection (OBI). Objectives: The current study aimed at determining the prevalence of OBI in Iranian DAA-naï ve HCV-infected patients with hemophilia. Methods: The current study was conducted on 100 patients with hemophilia receiving DAAs. The sera obtained from these patients were tested for the presence of HBsAg. Then, the presence of theHBVDNAwas detected inperipheral blood mononuclear cell (PBMC) and also plasma samples using nested polymerase chain reaction (PCR). Results: Among the 100 study subjects, 81 (81%) were male and 19 (19%) female. The mean age of the patients was 37  10. 50 years. All patients had previously received HBV vaccine. In the current study, HBV DNA was observed in 1% of plasma and in 3% of PBMC samples. In addition, none of the patients who had positive result for HBV detection test previously had markers of HBV infection (anti-HBc (HB core antigen) antibodies, anti-HBs antigens, and positive result of DNA PCR) and all had negative results for HCV RNA after treatment. Conclusions: Generally, the prevalence of OBI was low, but however, HBsAg negativity was not sufficient to completely exclude the presence of HBV DNA. Thus, the serological markers of HBV infection should be confirmed by molecular tests for the presence of possible OCCULT infection.

Background: Behcet’ s disease (BD) is a chronic multisystem vasculitis with an unknown etiology. During the past years, several reports are published on the OCCULT HEPATITIS B infection (OBI), the presence of HEPATITIS B virus (HBV) DNA in the absence of HBsAg, in rheumatic diseases. Objectives: The current study aimed to, firstly, investigate the prevalence of OBI in patients with BD, and, secondly, its potential association with the clinical and therapeutic status of BD. Methods: HBV serological markers and HBV DNA were evaluated in 220 consecutive BD patients to detect OBI. Demographic and clinical data of OBI positive and negative groups were compared. Results: The mean age of patients was 39. 24 ( 10. 57), and 134 (62. 9%) were male. The mean disease duration was 14. 13 ( 8. 63) years. No HBsAg positive case was found, but HBV DNA was found in 19 (8. 6%) patients. The median viral load value was 475. 84 copy/mL. We comparedclinical data of 10 OBI positiveand156 OBI negativeBDpatients with completeandaccessible data. Therewasnodifference between the two groups concerning demographic characteristics (age, sex, and disease duration), different clinical manifestations, or types of medications (immunomodulatory, cytotoxic, and corticosteroids). Conclusions: This is the first study showing a rather high prevalence of OBI among BD patients. We did not find any correlation between OBI positivity and different clinical manifestations, medications, or HLA-B51. Further studies are needed on a larger group of patients and by molecular HBV evaluation (as well as serologic) regarding this possible association.

Cryptogenic cirrhosis is a diagnosis of exclusion. Polymerase chain reaction (PCR) has demonstrated persistent HEPATITIS B virus (HBV) infection in serum and liver tissue of HBsAg-negative chronic HEPATITIS, HBsAg-negative cirrhosis, and HBsAg-negative HCC patients. The entity of OCCULT HBV infection is well established. We report two patients with OCCULT HBV related decompensated cirrhosis of liver for the first time from Bangladesh. The first patient is a young male with jaundice and hepato-splenomegaly. The second patient is also a young male with ascites. Both had altered liver function tests. Diagnosis of decompensated cirrhosis of liver was established in both cases and in both the etiology was identified by PCR to be OCCULT HBV infection. In areas with high prevalence of HBV, a diagnosis of "cryptogenic" cirrhosis based on HBsAg testing alone is not adequate. The so called "cryptogenic" but actually OCCULT HBV cirrhotics are suitable candidates for antiviral treatment. OCCULT HBV infection must be considered in all patients with cryptogenic cirrhosis of liver in areas where HBV infection is prevalent.

Background: HEPATITIS B virus (HBV) is responsible for chronic HEPATITIS B (CHB) and liver diseases. In the event of seroclearance or seroconversion, HEPATITIS B surface antigen (HBsAg) may be cleared or reduced to levels below the detection limit but very low quantities of viral DNA may be detectable as OCCULT HBV infection (OBI). Objectives: This study was conducted to estimate the prevalence of HBV DNA in the serum and PBMCs of individuals with HBsAg loss, with or without anti-HBs. Methods: Sixty out of 1116 patientswhoreferred to the private clinic were selectedanddivided intotwogroups: seroclearedandseroconverted. Serological markers of HBVwere measured by ELISA assayandHBVDNAin the plasma andperipheral blood mononuclear cell (PBMC) were measured by quantitative real time PCR. Results: A total of sixty cases (38 males, 22 females) with chronic HEPATITIS B were enrolled. The mean age of serocleared and seroconverted groups was 50. 5  13. 1and 49  11, respectively. Among the serocleared and seroconverted subjects, 3 and 2 became HBsAg positive, respectively. HBV DNA was detected in the PBMCs of four out of 27 serocleared patients (14. 8%) and three out of 28 seroconverted (10. 7%). By multivariate analysis, age, gender, duration of disease and serological situation of patients had no effects on patients’ relapse (P > 0. 05). Conclusions: In patients with CHB, who became HBsAg negative if the serum antibody is formed, there is a possibility of disease recurrence. Moreover, recurrence may be predicted considering the viral load in PBMCs.

IntroductionHEPATITIS B virus (HBV) infection is a global health problem. Current estimates are that 2 billion people have been infected worldwide, of these, 360 million suffer from chronic HBV infection resulting in over 520 000 deaths from acute HEPATITIS B and 470 000 from cirrhosis or liver cancer(1). The prevalence of HEPATITIS B carriers varies in different parts of the world, ranging from less than 1% to 15%. In the Middle East, the endemicity is intermittent, with a carrier rate of 2% to 7% (2). It is estimated that over 35% of Iranians have been exposed to the HBV and about 3% are chronic carriers, ranging from 1.7% in Fars Province to over 5% in Sistan and Balouchestan(3).