Dalian Blood Center, Dalian, China.
Dalian Public Health Clinical Center, Dalian, China.
J Viral Hepat. 2022 Nov;29(11):958-967. doi: 10.1111/jvh.13733. Epub 2022 Aug 24.
Absence of anti-HBc reactivity with detectable anti-HBs was observed in blood donors with occult hepatitis B virus (HBV) infection (OBI). The prevalence and mechanisms underlying this uncommon condition were investigated over time in Chinese blood donors with OBI. Isolated anti-HBs OBI status was identified from 466,911 donors from Dalian, China, and monitored in follow-up (range: 2.6-84.3 months). HBV vaccination status was documented, and infecting viral strains were characterized. Of 451 confirmed OBIs (1:1035), 43 (9.5%; 1:10,858) had isolated anti-HBs as only serological marker. Isolated anti-HBs OBIs differed from anti-HBc-reactive OBIs by significantly younger age (median 24 years), higher HBV DNA (median: 20 IU/ml) and anti-HBs (median 60.5 IU/L) levels, paucity of mutations in HBV Core and S proteins, and high vaccination rate (72%). Vaccinated isolated anti-HBs OBIs (n = 31) differed from unvaccinated (n = 11) by significantly younger age (22 vs 38 years), higher anti-HBs level at index (48% vs 9% with anti-HBs >100 IU/L) and higher frequency of anti-HBs immune response (44% vs 20%). Of 15 vaccinated and 5 unvaccinated OBIs follow-up, 65% (8 vaccinated and 5 unvaccinated) became HBV DNA negative suggesting aborted recent infection, while 35% (7 vaccinated) had low persistent viraemia 2 to 65 months post index. In conclusion, isolated anti-HBs OBI in Chinese blood donors appears associated with young, vaccinated, adults exposed to HBV who predominantly develop low level aborted infection revealed by transient HBV DNA and immune anti-HBs response. However, a subset of individuals still experienced low but persistent viral replication whose clinical outcome remains uncertain.
在隐匿性乙型肝炎病毒 (HBV) 感染 (OBI) 的献血者中，观察到抗-HBc 无反应性与可检测到的抗-HBs 同时存在。本研究旨在调查中国 OBI 献血者中这种不常见情况的流行率和潜在机制。从中国大连的 466911 名献血者中鉴定出孤立的抗-HBs OBI 状态，并在随访中进行监测（范围：2.6-84.3 个月）。记录了 HBV 疫苗接种状态，并对感染的病毒株进行了特征分析。在 451 例确诊的 OBI 中（1:1035），43 例（9.5%；1:10858）仅表现为血清学标志物孤立的抗-HBs。与抗-HBc 反应性 OBI 相比，孤立的抗-HBs OBI 具有显著更年轻的年龄（中位数 24 岁）、更高的 HBV DNA（中位数：20 IU/ml）和抗-HBs（中位数 60.5 IU/L）水平、HBV Core 和 S 蛋白突变较少以及高疫苗接种率（72%）。与未接种疫苗的孤立抗-HBs OBI（n=11）相比，接种疫苗的孤立抗-HBs OBI（n=31）的年龄显著更年轻（22 岁与 38 岁），在指数时的抗-HBs 水平更高（48%与 9%的抗-HBs>100 IU/L），并且抗-HBs 免疫反应的频率更高（44%与 20%）。在 15 例接种疫苗和 5 例未接种疫苗的 OBI 随访中，65%（8 例接种疫苗和 5 例未接种疫苗）的患者乙型肝炎病毒 DNA 转为阴性，提示近期感染被中止，而 35%（7 例接种疫苗）的患者在指数后 2-65 个月出现低水平持续病毒血症。总之，中国献血者中的孤立抗-HBs OBI 似乎与年轻、接种疫苗、接触 HBV 的成年人群有关，这些人群主要表现为短暂的 HBV DNA 和免疫抗-HBs 反应，导致低水平的中止感染。然而，仍有一部分个体出现持续的低水平病毒复制，其临床结局仍不确定。
