Occult Hepatitis B Virus Infection and Its Risks of Cryptic Transmission in Southern Ethiopia

Gizachew Beykaso; Andargachew Mulu; Mirutse Giday; Nega Berhe; Markos Selamu; Dawit Hailu; Tilahun Teklehaymanot

doi:10.2147/IDR.S344668

Occult Hepatitis B Virus Infection and Its Risks of Cryptic Transmission in Southern Ethiopia

Infect Drug Resist. 2022 Feb 24:15:619-630. doi: 10.2147/IDR.S344668. eCollection 2022.

Authors

Gizachew Beykaso^{1

2}, Andargachew Mulu³, Mirutse Giday¹, Nega Berhe¹, Markos Selamu², Dawit Hailu³, Tilahun Teklehaymanot¹

Affiliations

¹ Aklilu Lemma Institute of Pathobiology, Department of Molecular Biology and Immunology, Addis Ababa University, Addis Ababa, Ethiopia.
² College of Medicine and Health Sciences, Department of Public Health, Wachemo University, Hossana, Ethiopia.
³ Armauer Hansen Research Institute, Department of Virology, Addis Ababa, Ethiopia.

Abstract

Background: The detection of hepatitis B virus surface antigen (HBsAg) in serum remains the mainstay in diagnosing and screening of hepatitis B virus (HBV) in most developing countries. The absence of HBsAg in the blood may not indicate the absence of circulating HBV and might be infectious. Thus, this study aimed to estimate the burden and its cryptic transmission risks of occult hepatitis B infection (OBI) among HBsAg negative healthy individuals in Southern Ethiopia.

Methods: A community-based cross-sectional study was conducted from September 2020 to January 2021. Serum samples were collected and assayed for HBsAg and HBV core antibody (anti-HBc) seromarkers using enzyme-linked immunosorbent assay (ELISA). In anti-HBc positive samples, HBV DNA was detected using real-time polymerase chain reaction (RT-PCR). Data were entered into Epi-Data version 3.1, cleaned, and analyzed using SPSS version 21.0. Descriptive and logistic regression analyses were employed. Statistical significance was decided at p < 0.05.

Results: A total of 346 were individuals included in this study; 34 (9.8%) were tested positive for HBsAg. The rest 312 (90.2%) negatively tested were further assayed for anti-HBc, and 115 (36.7%) were found positive implying previous exposure to HBV, and 21 (18.3%) out of 115 anti-HBc positives had HBV DNA signifying OBI. The HBV DNA concentration below 200 IU/mL was 85.7%. A high rate of OBI was observed among individuals who had multiple sexual contacts, a family history of hepatitis, and tattooing.

Conclusion: In this study, the prevalence of OBI is high. This indicates the burden of HBV is considerable since screening is exclusively dependent on HBsAg which will not eliminate the possibility of residual cryptic transmission through blood donation, organ transplantation, perinatal transmission, and other contacts. Our results demonstrate that nucleic acid-based testing (NAT) should be an essential part of screening to prevent missing OBI.

Keywords: HBV; HBV DNA; OBI; Southern Ethiopia; anti-HBc.

Grants and funding

Funding for this study was made possible through grants obtained by Addis Ababa University. The funder had no part in the conceptualization and designing of the study, data processing, and decision to publish, or preparation of the manuscript.