Baylor College of Medicine, Houston, TX 77030, USA.
J Viral Hepat. 2010 Jan;17(1):1-15. doi: 10.1111/j.1365-2893.2009.01245.x. Epub 2009 Dec 9.
Detection of occult hepatitis B requires assays of the highest sensitivity and specificity with a lower limit of detection of less than 10 IU/mL for hepatitis B virus (HBV) DNA and <0.1 ng/mL for hepatitis B surface antigen (HBsAg). This covert condition is relatively common in patients with chronic hepatitis C virus (HCV) that seems to exert some influence on the replicative capacity and latency of HBV. Detection of virus-specific nucleic acid does not always translate into infectivity, and the occurrence of primer-generated HBV DNA that is of partial genomic length in immunocompetent individuals who have significant levels of hepatitis B surface antibody (anti-HBs) may not be biologically relevant. Acute flares of alanine aminotransferase (ALT) that occur during the early phase of therapy for HCV or ALT levels that remain elevated at the end of therapy in biochemical nonresponders should prompt an assessment for occult hepatitis B. Similarly, the plasma from patients with chronic hepatitis C that is hepatitis B core antibody (anti-HBc) positive (+/-anti-HBs at levels of <100 mIU/mL) should be examined for HBV DNA with the most sensitive assay available. If a liver biopsy is available, immunostaining for hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) should be contemplated and a portion of the sample tested for HBV DNA. This is another reason for optimal collection of a specimen (e.g. two passes with a 16-guage needle under ultrasound guidance). Transmission of HBV to immunosuppressed orthotopic liver transplant recipients by donors with occult hepatitis B (OHB) will continue to occupy the interests of the transplant hepatologist. As patients with OHB may have detectable HBV DNA in serum, peripheral blood mononuclear cells (PBMC) and/or liver that can be reactivated following immunosuppression or intensive cytotoxic chemotherapy, the patient needs to be either monitored or treated depending on the pretreatment serological results such as an isolated anti-HBc reaction or a detectable HBV DNA.
隐匿性乙型肝炎的检测需要使用最高灵敏度和特异性的检测方法，乙型肝炎病毒 (HBV) DNA 的检测下限应<10IU/mL，乙型肝炎表面抗原 (HBsAg) 的检测下限应<0.1ng/mL。这种隐匿性感染在慢性丙型肝炎病毒 (HCV) 患者中相对常见，似乎对 HBV 的复制能力和潜伏性有一定影响。病毒特异性核酸的检测并不总是意味着具有传染性，在具有大量乙型肝炎表面抗体 (抗-HBs) 的免疫功能正常个体中，可能会出现部分基因组长度的引物生成 HBV DNA，这可能在生物学上并不相关。在 HCV 治疗的早期阶段，丙氨酸氨基转移酶 (ALT) 出现急性升高，或在生化无应答者治疗结束时 ALT 水平仍升高，应提示进行隐匿性乙型肝炎评估。同样，慢性丙型肝炎患者的血浆，如果乙型肝炎核心抗体 (抗-HBc) 阳性 (+/-抗-HBs 水平<100mIU/mL)，应使用最敏感的检测方法检测 HBV DNA。如果有肝活检标本，应考虑对乙型肝炎表面抗原 (HBsAg) 和乙型肝炎核心抗原 (HBcAg) 进行免疫染色，并对部分标本进行 HBV DNA 检测。这也是优化标本采集的另一个原因（例如在超声引导下使用 16 号针进行两次穿刺）。隐匿性乙型肝炎供体向免疫抑制原位肝移植受者传播乙型肝炎病毒 (HBV) 将继续引起移植肝病学家的关注。由于隐匿性乙型肝炎患者的血清、外周血单核细胞 (PBMC) 和/或肝脏中可能存在可检测到的 HBV DNA，在免疫抑制或强化细胞毒性化疗后可能会被重新激活，因此需要根据预处理血清学结果（如单独的抗-HBc 反应或可检测到的 HBV DNA）对患者进行监测或治疗。
