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Cited by 92Hepatitis B Virus StudiesHepatitis C virus researchLiver Disease and Transplantation

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Prevalence of occult hepatitis B virus infection in adults: a systematic review and meta-analysis

Open access
Im, Yu Ri, Jagdish, Rukmini, Leith, Damien, Kim, Jin Un, Yoshida, Kyoko, Majid, Amir, Ge, Yueqi, Ndow, Gibril, Shimakawa, Yusuke, Lemoine, Maud·2022·The Lancet Gastroenterology & Hepatology
DOI 10.1016/s2468-1253(22)00201-1PMC PMC9630161
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Abstract

BACKGROUND: Despite growing concerns about transmissibility and clinical impact, occult hepatitis B virus (HBV) infection has received little attention in the hepatitis elimination agenda. We aimed to estimate the prevalence of occult HBV infection at a global and regional scale and in specific populations. METHODS: For this systematic review and meta-analysis, we searched the MEDLINE, Embase, Global Health, and Web of Science databases for articles published in any language between Jan 1, 2010, and Aug 14, 2019. We included original articles and conference abstracts of any study design that reported the proportion of HBsAg-negative adults (aged ≥18 years) who are positive for HBV DNA (ie, people with occult HBV infection). The prevalence of occult HBV infection was pooled, using the DerSimonian-Laird random-effects model, in the general population and specific groups defined by the type of study participants (blood donors; other low-risk populations; high-risk populations; and people with advanced chronic liver disease), and stratified by HBV endemicity in each country. We also assessed the performance of anti-HBc as an alternative biomarker to detect occult HBV infection. The study was registered with PROSPERO, CRD42019115490. FINDINGS: 305 of 3962 articles were eligible, allowing a meta-analysis of 140 521 993 individuals tested for HBV DNA. Overall, only two studies evaluated occult HBV infection in the general population, precluding unbiased global and regional estimates of occult HBV infection prevalence. In blood donors, occult HBV infection prevalence mirrored HBV endemicity: 0·06% (95% CI 0·00-0·26) in low-endemicity countries, 0·12% (0·04-0·23) in intermediate-endemicity countries, and 0·98% (0·44-1·72), in high-endemicity countries (p=0·0012). In high-risk groups, occult HBV infection prevalence was substantial, irrespective of endemicity: 5·5% (95% CI 2·9-8·7) in low-endemicity countries, 5·2% (2·5-8·6) in intermediate-endemicity countries, and 12·0% (3·4-24·7) in high-endemicity countries. The pooled sensitivity of anti-HBc to identify occult HBV infection was 77% (95% CI 62-88) and its specificity was 76% (68-83). INTERPRETATION: A substantial proportion of people carry occult HBV infection, especially among high-risk groups across the globe and people living in highly endemic countries. Occult HBV infection should be part of the global viral hepatitis elimination strategy. FUNDING: None.

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Figure 1 Study selection HBV=hepatitis B virus. OBI=occult HBV infection.
Figure 1 Study selection HBV=hepatitis B virus. OBI=occult HBV infection.CC BY · PubMed Central
Figure 2 Prevalence of occult HBV infection by type of study population and country endemicity Low-risk populations include the general population, healthy health-care workers, and pregnant women; high-risk populations include patients living with HIV, patients infected with hepatitis C virus, or patients on haemodialysis. HBV=hepatitis B virus.
Figure 2 Prevalence of occult HBV infection by type of study population and country endemicity Low-risk populations include the general population, healthy health-care workers, and pregnant women; high-risk populations include patients living with HIV, patients infected with hepatitis C virus, or patients on haemodialysis. HBV=hepatitis B virus.CC BY · PubMed Central
Figure 3 Pooled sensitivity and specificity of anti-HBc to indicate the presence of occult HBV infection HBV=hepatitis B virus.
Figure 3 Pooled sensitivity and specificity of anti-HBc to indicate the presence of occult HBV infection HBV=hepatitis B virus.CC BY · PubMed Central

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Citations

Cites

Research works printed but not linked: 27

  1. Raimondo, 2019, Update of the statements on biology and clinical impact of occult hepatitis B virus infection, J Hepatol, 71, 397, 10.1016/j.jhep.2019.03.034 · DOI · Paper page
  2. Raimondo, 2008, Statements from the Taormina expert meeting on occult hepatitis B virus infection, J Hepatol, 49, 652, 10.1016/j.jhep.2008.07.014 · DOI
  3. Yamamoto, 1994, Naturally occurring escape mutants of hepatitis B virus with various mutations in the S gene in carriers seropositive for antibody to hepatitis B surface antigen, J Virol, 68, 2671, 10.1128/jvi.68.4.2671-2676.1994 · DOI
  4. Hass, 2005, Functional analysis of hepatitis B virus reactivating in hepatitis B surface antigen-negative individuals, Hepatology, 42, 93, 10.1002/hep.20748 · DOI
  5. Cohen, 2020, Hepatitis B virus preS2Δ38-55 variants: a newly identified risk factor for hepatocellular carcinoma, JHEP Rep, 2
  6. Allain, 2016, Global epidemiology of occult HBV infection, Ann Blood, 2, 7, 10.21037/aob.2017.06.01 · DOI
  7. Mak, 2020, Occult hepatitis B infection and hepatocellular carcinoma: epidemiology, virology, hepatocarcinogenesis and clinical significance, J Hepatol, 73, 952, 10.1016/j.jhep.2020.05.042 · DOI · Paper page
  8. Weng, 2021, Occult hepatitis B virus infection and the risk of hepatocellular carcinoma: a systematic review and meta-analysis, Dig Med Res, 4, 46, 10.21037/dmr-21-50 · DOI
  9. Candotti, 2019, Multiple HBV transfusion transmissions from undetected occult infections: revising the minimal infectious dose, Gut, 68, 313, 10.1136/gutjnl-2018-316490 · DOI
  10. Harvala, 2021, Hepatitis B infections among blood donors in England between 2009 and 2018: is an occult hepatitis B infection a risk for blood safety?, Transfusion, 61, 2402, 10.1111/trf.16543 · DOI
  11. Chevaliez, 2010, Performance of version 2.0 of the Cobas AmpliPrep/Cobas TaqMan real-time PCR assay for hepatitis B virus DNA quantification, J Clin Microbiol, 48, 3641, 10.1128/JCM.01306-10 · DOI
  12. Hoy, 2012, Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement, J Clin Epidemiol, 65, 934, 10.1016/j.jclinepi.2011.11.014 · DOI · Paper page
  13. Schweitzer, 2015, Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013, Lancet, 386, 1546, 10.1016/S0140-6736(15)61412-X · DOI
  14. 2018, Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study, Lancet Gastroenterol Hepatol, 3, 383, 10.1016/S2468-1253(18)30056-6 · DOI
  15. Zhang, 2013, Epidemiological and clinical features of occult hepatitis B in HIV infection without antiretroviral treatment, Zhonghua Gan Zang Bing Za Zhi, 21, 189
  16. Minuk, 2014, Establishing diagnostic criteria for occult hepatitis B virus infections in community based populations, J Med Virol, 86, 156, 10.1002/jmv.23813 · DOI
  17. Candotti, 2012, Occult hepatitis B infection in blood donors from South East Asia: molecular characterisation and potential mechanisms of occurrence, Gut, 61, 1744, 10.1136/gutjnl-2011-301281 · DOI
  18. Taira, 2013, Residual risk of transfusion-transmitted hepatitis B virus (HBV) infection caused by blood components derived from donors with occult HBV infection in Japan, Transfusion, 53, 1393, 10.1111/j.1537-2995.2012.03909.x · DOI
  19. Yuen, 2011, Transmissibility of hepatitis B virus (HBV) infection through blood transfusion from blood donors with occult HBV infection, Clin Infect Dis, 52, 624, 10.1093/cid/ciq247 · DOI
  20. Cooke, 2019, Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission, Lancet Gastroenterol Hepatol, 4, 135, 10.1016/S2468-1253(18)30270-X · DOI
  21. Oluyinka, 2015, Occult hepatitis B virus infection in Nigerian blood donors and hepatitis B virus transmission risks, PLoS One, 10, 10.1371/journal.pone.0131912 · DOI
  22. Ndow, 2021, Prevalence and clinical significance of occult hepatitis B infection in The Gambia, West Africa, J Infect Dis
  23. Shi, 2012, Association between occult hepatitis B infection and the risk of hepatocellular carcinoma: a meta-analysis, Liver Int, 32, 231, 10.1111/j.1478-3231.2011.02481.x · DOI
  24. Chen, 2017, Hepatitis B reactivation in hepatitis B and C coinfected patients treated with antiviral agents: a systematic review and meta-analysis, Hepatology, 66, 13, 10.1002/hep.29109 · DOI
  25. Wong, 2022, Detection of the hepatitis B surface antigen in patients with occult hepatitis B by use of an assay with enhanced sensitivity, J Clin Microbiol, 60, 10.1128/jcm.02204-21 · DOI
  26. Whittle, 1990, The pattern of childhood hepatitis B infection in two Gambian villages, J Infect Dis, 161, 1112, 10.1093/infdis/161.6.1112 · DOI
  27. Shahmoradi, 2012, High prevalence of occult hepatitis B virus infection in children born to HBsAg-positive mothers despite prophylaxis with hepatitis B vaccination and HBIG, J Hepatol, 57, 515, 10.1016/j.jhep.2012.04.021 · DOI

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Metadata

Authors
Im, Y. R., Jagdish, R., Leith, D., Kim, J. U., Yoshida, K., Majid, A., Ge, Y., Ndow, G., Shimakawa, Y., & Lemoine, M.
Affiliations
  • Imperial College London (GB)
  • Chelsea and Westminster Hospital (GB)
  • Glasgow Royal Infirmary (GB)
  • The Royal Free Hospital (GB)
  • Tokyo Medical and Dental University (JP)
  • West Middlesex University Hospital (GB)
  • Chelsea and Westminster Hospital NHS Foundation Trust (GB)
  • London School of Hygiene & Tropical Medicine (GB)
  • Institut Pasteur (FR)
Corresponding author
Lemoine, Maud
ORCID
Venue
The Lancet Gastroenterology & Hepatology
Publisher
Elsevier BV
Published
2022-10
Volume
7
Issue
10
Pages
932-942
ISSN
  • 2468-1156 (ISSN-L)
  • 2468-1253
DOI
10.1016/s2468-1253(22)00201-1
PMC
PMC9630161
OpenAlex
W4291286539
Cited by
92
References
2
Citations by year
2026: 25 · 2025: 26 · 2024: 23 · 2023: 16 · 2022: 2
FWCI
2.66
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet. Gastroenterology & hepatology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Discovery Research Portal (University of Dundee) (publishedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • HAL (submittedVersion, cc-by)
Funders
  • Wellcome Trust
  • Medical Research Council
  • Gilead Sciences
Topics
  • Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
  • Health Sciences › Medicine › Hepatology › Hepatitis C virus research
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
occult hepatitis B infection, HBV DNA, HBsAg-negative, prevalence, blood donors, HBV endemicity, anti-HBc, HBV reactivation, chronic liver disease, HBV elimination, vulnerable populations, hepatitis B screening, HBV genotypes, HBV genotyping
MeSH terms
Adolescent, Adult, DNA, Viral, Hepatitis B, Hepatitis B Antibodies, Hepatitis B virus, Humans, Prevalence, Hepatitis B, Chronic

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