Eslami Narges, Poortahmasebi Vahdat, Sadeghi Javid, Ghotaslou Reza, Niknafs Bahram, Bannazadeh Baghi Hossein, Ahangar Oskouee Mahin
Department of Microbiology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Can J Infect Dis Med Microbiol. 2022 Jun 28;2022:3838857. doi: 10.1155/2022/3838857. eCollection 2022.
Regardless of the extensive screening for the detection of hepatitis B surface antigen (HBsAg), hemodialysis (HD) patients are still severely at the risk of occult hepatitis B virus infection (OBI), especially in developing countries. OBI is defined as the presence of HBV DNA with undetectable HBsAg in the liver and/or Serum. This study aims to determine the prevalence of OBI in HD patients in Tabriz Province, northwest of Iran, and inquire about the mutations in the detected HBsAg. In this cross-sectional descriptive study, ELISA method assessed serum and plasma samples of 118 HBsAg-negative patients undergoing HD treatment for HBV serological markers (HBsAg and Anti-HBc). Specific primers by nested polymerase chain reaction have been utilized to examine HBV DNA; also, direct sequencing of surface genes was carried out to characterize the viral genotypes and S gene mutations. Finally, followed by real-time PCR, the quantity of viral load in OBI-positive patients was determined. A total of 118 HD patients were included (63.6% were male and 36.4% female), with an overall mean age of 60.8 ± 12.8 years old. The prevalence of antihepatitis B core antibody (Anti-HBc) in the study population was 26.3% (31/118). Five patients (4.2%) were positive for HBV DNA and labeled OBI-positive; their plasma HBV-DNA load was less than 100 IU/ml. Following the phylogenetic analysis, the samples with OBI roughly belonged to genotype D, subtype ayw2 and only two had mutations within the S 'gene's major hydrophilic region (MHR), including T123I, C124F, and P127T. This study reports the prevalence of OBI in the HBsAg-negative HD patients being at a rate of 4.2%, which can be a clinically vital consideration in this region. HBV serologic screening approaches need to be renewed to cover nucleic acid testing in the setting of hemodialysis and all the other high-risk groups associated with it (i.e., blood and organ donors).
尽管对乙肝表面抗原（HBsAg）检测进行了广泛筛查，但血液透析（HD）患者仍面临隐匿性乙肝病毒感染（OBI）的严重风险，尤其是在发展中国家。OBI被定义为肝脏和/或血清中存在乙肝病毒DNA但HBsAg检测不到。本研究旨在确定伊朗西北部大不里士省HD患者中OBI的患病率，并探究检测到的HBsAg中的突变情况。在这项横断面描述性研究中，采用酶联免疫吸附测定（ELISA）方法评估了118例接受HD治疗的HBsAg阴性患者的血清和血浆样本中的乙肝血清学标志物（HBsAg和抗-HBc）。利用巢式聚合酶链反应的特异性引物检测乙肝病毒DNA；此外，对表面基因进行直接测序以鉴定病毒基因型和S基因突变。最后，通过实时聚合酶链反应确定OBI阳性患者的病毒载量。共纳入118例HD患者（男性占63.6%，女性占36.4%），总体平均年龄为60.8±12.8岁。研究人群中抗乙肝核心抗体（抗-HBc）的患病率为26.3%（31/118）。5例患者（4.2%）乙肝病毒DNA呈阳性，被标记为OBI阳性；其血浆乙肝病毒DNA载量低于100 IU/ml。经过系统发育分析，OBI样本大致属于D基因型，ayw2亚型，只有两个样本在S基因的主要亲水区域（MHR）内存在突变，包括T123I、C124F和P127T。本研究报告了HBsAg阴性HD患者中OBI的患病率为4.2%，这在该地区可能具有重要的临床意义。需要更新乙肝血清学筛查方法，以涵盖血液透析及与之相关的所有其他高危人群（即血液和器官捐献者）中的核酸检测。
