Brief Article
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World J Hepatol. Feb 27, 2013; 5(2): 64-73
Published online Feb 27, 2013. doi: 10.4254/wjh.v5.i2.64
Occult hepatitis B virus infection among Egyptian blood donors
Zeinab N Said, Manal H El Sayed, Iman I Salama, Enas K Aboel-Magd, Magda H Mahmoud, Maged El Setouhy, Faten Mouftah, Manal B Azzab, Heidi Goubran, Amal Bassili, Gamal E Esmat
Zeinab N Said, Enas K Aboel-Magd, Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, 11511 Cairo, Egypt
Manal H El Sayed, Pediatric Department, Hematology/Oncology Division, Faculty of Medicine, Ain Shams University, 11511 Cairo, Egypt
Iman I Salama, Community Medicine Department, National Research Center, 12411 Giza, Egypt
Magda H Mahmoud, Ain-Shams Maternity and Women’s University Hospital, 11511 Cairo, Egypt
Maged El Setouhy, Community, Enviromental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, 11511 Cairo, Egypt
Faten Mouftah, Manal B Azzab, Heidi Goubran, National Blood Transfusion Center, 11511 Cairo, Egypt
Amal Bassili, TB Surveillance officer, STB/WHO/EMRO. Focal point, Tropical Disease Research, 11511 Cairo, Egypt
Gamal E Esmat, Tropical Medicine Department, Faculty of Medicine-Cairo University, 11511 Cairo, Egypt
Author contributions: Said ZN, El Sayed MH, Salama II, El Setouhy M, Mouftah F, Bassili A and Esmat GE contributed to generating the ideas and research design for this work; Said ZN, El Sayed MH, Salama II, Basili A and Esmat GE contributed to the supportive work and supervision; Mahmoud MH and Goubran H recruited patients and collected samples; Azzab MB performed the chemical laboratory work; Said ZN and Aboel-Magd EK performed the serology and Said ZN performed the molecular biology work, contributed towards the conception of the work and wrote the paper; Salama II statistically analyzed the data and El Sayed MH and Salama II revised the paper. All authors give final approval of the version to be published.
Correspondence to: Zeinab N Said, Professor, Microbiology and Immunology Department, Faculty of Medicine (for girls), Al-Azhar University, Nasr City, 8 Ossama Ibn Monkez Street, Heliopolis, 11511 Cairo, Egypt.
Telephone: +20-2-4187236 Fax: +20-2-2571305
Received: July 1, 2012
Revised: November 28, 2012
Accepted: December 23, 2012
Published online: February 27, 2013

AIM: To identify blood donors with occult hepatitis B virus (HBV) infection (OBI) to promote safe blood donation.

METHODS: Descriptive cross sectional study was conducted on 3167 blood donors negative for hepatitis B surface antigen (HBsAg), hepatitis C antibody (HCV Ab) and human immunodeficiency virus Ab. They were subjected to the detection of alanine aminotransferase (ALT) and aspartate transaminase (AST) and screening for anti-HBV core antibodies (total) by two different techniques; [Monoliza antibodies to hepatitis B core (Anti-HBc) Plus-Bio-Rad] and (ARC-HBc total-ABBOT). Positive samples were subjected to quantitative detection of antibodies to hepatitis B surface (anti-HBs) (ETI-AB-AUK-3, Dia Sorin-Italy). Serum anti-HBs titers > 10 IU/L was considered positive. Quantitative HBV DNA by real time polymerase chain reaction (PCR) (QIAGEN-Germany) with 3.8 IU/mL detection limit was estimated for blood units with negative serum anti-HBs and also for 32 whose anti-HBs serum titers were > 1000 IU/L. Also, 265 recipients were included, 34 of whom were followed up for 3-6 mo. Recipients were investigated for ALT and AST, HBV serological markers: HBsAg (ETI-MAK-4, Dia Sorin-Italy), anti-HBc, quantitative detection of anti-HBs and HBV-DNA.

RESULTS: 525/3167 (16.6%) of blood units were positive for total anti-HBc, 64% of those were anti-HBs positive. Confirmation by ARCHITECT anti-HBc assay were carried out for 498/525 anti-HBc positive samples, where 451 (90.6%) confirmed positive. Reactivity for anti-HBc was considered confirmed only if two positive results were obtained for each sample, giving an overall prevalence of 451/3167 (14.2%) for total anti-HBc. HBV DNA was quantified by real time PCR in 52/303 (17.2%) of anti-HBc positive blood donors (viral load range: 5 to 3.5 x 105 IU/mL) with a median of 200 IU/mL (mean: 1.8 x 104± 5.1 x 104 IU/mL). Anti-HBc was the only marker in 68.6% of donors. Univariate and multivariate logistic analysis for identifying risk factors associated with anti-HBc and HBV-DNA positivity among blood donors showed that age above thirty and marriage were the most significant risk factors for prediction of anti-HBc positivity with AOR 1.8 (1.4-2.4) and 1.4 (1.0-1.9) respectively. Other risk factors as gender, history of blood transfusion, diabetes mellitus, frequent injections, tattooing, previous surgery, hospitalization, Bilharziasis or positive family history of HBV or HCV infections were not found to be associated with positive anti-HBc antibodies. Among anti-HBc positive blood donors, age below thirty was the most significant risk factor for prediction of HBV-DNA positivity with AOR 3.8 (1.8-7.9). According to HBV-DNA concentration, positive samples were divided in two groups; group one with HBV-DNA ≥ 200 IU/mL (n = 27) and group two with HBV-DNA < 200 IU/mL (n = 26). No significant difference was detected between both groups as regards mean age, gender, liver enzymes or HBV markers. Serological profiles of all followed up blood recipients showed that, all were negative for the studied HBV markers. Also, HBV DNA was not detected among studied recipients, none developed post-transfusion hepatitis (PTH) and the clinical outcome was good.

CONCLUSION: OBI is prevalent among blood donors. Nucleic acid amplification/HBV anti core screening should be considered for high risk recipients to eliminate risk of unsafe blood donation.

Keywords: Hepatitis B virus, Total anti-HBc, Occult hepatitis B virus infection, Hepatitis B surface antigen, Hepatitis B virus-DNA