With the improvement of detection technology, especially the improvement of nucleic acid detection sensitivity, it has been found in clinical practice that some individuals can not detect HBsAg in their serum with commercial kits, but can detect low level of HBV DNA in their liver or blood, which is called latent HBV infection.Occult HBV infection is difficult to diagnose clinically, but it can lead to chronic progression of the disease, eventually leading to cirrhosis and even hepatocellular carcinoma.
Recently, in the APASL 2020 liver fibrosis, 2017, chairman of the American Association for the Study of Liver Diseases (AASLD), university of Michigan Prof.Anna Lok,make the speech "Controversies and New Perspectives in Occult Hepatitis B Infection (Occult Hepatitis B Infection of controversy and New ideas)", caused wide public concern.After the meeting, Hepatology Digest invited Professor Anna Lok to talk about hidden hepatitis B infection.The details are as follows.
<Hepatology Digest> : What is the prevalence of occult hepatitis B infection?
Dr Lok: As I mentioned in my talk, it is highly variable depending on the study population, the country in which the study is done, and the definition, sensitivity and specificity of the methods used. There is no single answer.
<Hepatology Digest> : For which patients should the possibility of occult hepatitis B infection be considered?
Dr Lok: If you have a patient with liver cancer, and there isn’t an underlying etiology, you might consider occult hepatitis B infection and should look for evidence. So, in patients with liver disease, and particularly liver cancer, where there is no underlying etiology that you can identify, look for occult hepatitis B infection. Certainly in the blood donor setting, if you have transmission of hepatitis B infection, you have to look at the possibilities of how that slipped through. It may be because the donor had occult hepatitis B.
<Hepatology Digest> : How do we diagnose occult hepatitis B infection in patients with undetectable HBV DNA in their serum?
Dr Lok: Ideally, if you have access to liver tissue, which most us don’t. More commonly, for large-scale study, we rely on the detection of hepatitis B core antibody.
<Hepatology Digest> :For which patients with occult hepatitis B should prophylactic antiviral therapy or antiviral therapy be considered?
Dr Lok: They do not need to be put on antiviral therapy. However, if they need to receive immunosuppressive therapy, then prophylactic antiviral therapy should be considered. The reason for considering prophylactic antivirals is because for bone marrow transplantation, very potent immunosuppressive therapy is required, such as anti-CD20.
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