Occult Hepatitis B Virus Infection: Transmission and Reactivation

Sang Hee Song; Seong Gyu Hwang

doi:10.4166/kjg.2013.62.3.148

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Song and Hwang: Occult Hepatitis B Virus Infection: Transmission and Reactivation

Review Article

Korean J Gastroenterol 2013;62(3):148-153.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.3.148

Occult Hepatitis B Virus Infection: Transmission and Reactivation

Sang Hee Song, Seong Gyu Hwang

Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Correspondence to: Seong Gyu Hwang, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea. Tel: +82-31-780-5213, Fax: +82-31-780-5246, E-mail: sghwang@cha.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Occult HBV infection (OBI) is defined as presence of HBV DNA in the liver tissue in patients with serologically undetectable HBsAg. There are differences in virologic and serological profiles of OBI. Majority of OBI are positive for anti-HBs and/or anti-HBc and minor portion are negative for all HBV markers. However, there are no HBV mutations in the surface and its regulatory regions. HBV infection persists by the presence of covalently closed circular DNA (cccDNA) within the infected hepatocytes, which serves as a reservoir for future infection. OBI increases the risk of HBV transmission through transfusion, hemodialysis, and organ transplantation. Therefore effective measures should be employed to screen OBI. Antiviral therapy is needed in HBsAg-negative transplant patients who are anti-HBc positive to prevent the recurrence of HBV infection. Since HBV replication is strongly suppressed by immune surveillance system in OBI patients, immunosuppression results in massive HBV replication. This leads to acute hepatitis and sometimes mortality when immune surveillance is recovered after stopping immunosuppressive drugs/anticancer chemotherapy. Therefore, narrow surveillance is required to recognize the viral reactivation and start antiviral agents during immunosuppressive therapy/anticancer chemotherapy in patients with OBI.

Keywords: Hepatitis B virus, Occult infection, Reactivation, Immunosuppression, Hepatitis B surface antigens

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Fig. 1.

Seropositive and seronegative occult HBV infection. Majority of occult HBV infections are positive for anti-HBs and/or anti-HBc and minor portion are negative for all HBV markers.

Table 1.

Reactivation of Occult HBV Reported in Korea

Case	Authors	Year of study	Sex/ age (yr)	Disease	Cause of immune suppression	Time to reactivation	Serotype	Treatment	Clinical course
1	Kim et al.²⁸	2008	F/66	Diffuse large B cell lymphoma	Rituximab-CHOP	Not reactivated	Anti-HBs(＋)	Preemptive treatment (lamivudine)	Improved
2	Chung et al.²⁹	2010	F/70	Diffuse large B cell lymphoma	Rituximab-CHOP	8 months	Anti-HBs(＋)/anti-HBc(＋)	Entecavir	Expired due to fuminent hepatitis
3	Ha et al.³⁰	2011	F/60	HCV liver cirrhosis	Orthotopic liver transplantation	0.5 month	Anti-HBs(＋)/anti-HBc(−)	Clevudine	Expired due to gastric cancer
4	Jung et al.³¹	2012	F/56	Diffuse large B cell lymphoma	Rituximab-CHOP	14 months	Anti-HBs(＋)/anti-HBc(＋)	Entecavir	Improved

F, female; CHOP, cyclophosphamide, adriamycin, vincristine, prednisone.

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