Occult Hepatitis B among Patients under Hemodialysis at Mansoura University Hospitals: Prevalence and Risk Factors Maysaa El Sayed Zaki 1 , Douaa Rafaat 1 , Ahmed Eliwa 1 and Mostafa Abdelsalam 2 1 Clinical Pathology Department, Mansoura faculty of Medicine, Egypt 2 Internal Medicine Department, Mansoura faculty of Medicine, Egypt * Corresponding author: Maysaa El Sayed Zaki, Mansoura-Rabaea street, Egypt, Email: may_s65@hotmail.com Rec date: Feb 18, 2014 Acc date: April 22, 2014 Pub Date: April 25, 2014 Abstract: Background: In spite of the progress made in the prevention of transfusion transmitted infections over the last decade, transmission of hepatitis viruses like B and C infection through transfusion of serologically negative blood has been documented among susceptible patients who are under hemodialysis due to end stage renal failure. Aim: The present study was performed to diagnose Occult Hepatitis B among patients under hemodialysis at Mansoura University Hospitals and to determine the risk factors for such infection. Material and method: The study was conducted on 96 patients attending Mansoura University hospitals for hemodialysis with age range from 26 to 65 years. In addition, one hundred sixty seven healthy blood donors were included in the study and considered as a control group. Blood samples were obtained from each subject and subjected to full biochemical analysis for liver function tests and serological markers for hepatitis C IgG (HCV IgG), hepatitis B surface antigen (HBsAg), hepatitis B surface antibody(HBs Ab), hepatitis B core IgG and IgM (HBc IgG & HBc IgM). Furthermore molecular study for hepatitis B viral DNA and its genotypes were performed by multiplex polymerase chain reaction. Results: HBV DNA was detected in 18(18.8%) compared to blood donors (2.4%) with statistically significant difference (P=0.0001). Hepatitis core IgG was positive in 19 patients (19.8%) compared to control group (2.4%). The majority of patients under hemodialysis had positive HBV DNA in absence of any serological markers (72.2%). The genotypes of hepatitis B virus in patients under hemodialysis were mainly C (44.4%), followed by A (27.8%) then B (22.2%), while in healthy control only two genotypes were detected C (50%) and mixed type D&F type (50%) with statistically significant difference between patients and control subjects (P=0,0001). Risk factors analysis for occult hepatitis B in patients under hemodialysis revealed significant association between duration of hemodialysis (P=0, 0001-95%CI 1.01-1.05) and the numbers of transfused blood units (P=.0001 95%CI 1.1-1.5). Conclusion: From this study we can conclude that occult hepatitis B is mundane among hemodialysis patients. The prolonged duration of dialysis and the number of blood units are major risk factors for acquiring such infection. Keywords: Hemodialysis; Occult hepatitis B virus; Seronegative Introduction Hepatitis B virus (HBV) represents a global health quandary. Among susceptible subjects to this infection those who are on maintenance hemodialysis (HD). The prevalence of HBV infection in HD patients varies markedly from country to country according to the endemicity of the hepatitis viruses [1]. The potential source for hepatitis B virus infection on hemodialysis patients are the practice of multiple blood transfusions making the hospital acquired infections in these patients’ earnest complications. The infection with hepatitis B can lead to cryptogenic liver disease; contribute to acute exacerbation of chronic hepatitis B, or even fulminant hepatitis. Generally, the occurrence of transfusion- transmitted hepatitis B has been steadily reduced over the last years due to the efficacious practice of vaccination [2]; however HBV still remains among mundane virus transmitted by frequent blood transfusions like hepatitis C [3-5]. Screening for blood and blood products is being carried out in national blood banks in Egypt for Hepatitis C virus (HCV) by tenaciousness of categorical immunoglobulin G (IgG) HCV, human immunodeficiency virus (HIV) by IgG and for HBV by hepatitis B virus surface antigen (HBsAg). For HBV the screening method is by resoluteness of concrete antigen S. being the first-line of blood screening for HBV [6]. However, there is growing cognizance that transmission by HBsAg-negative blood may occur during the serologically negative window period, either with positive or negative serological markers for HBV and this situation is referred to as occult HBV infection (OBI) [7,8]. Occult HBV infection was initially described in the tardy 1970 by Tabor et al, 1979 [9] and it is characterized by the presence of HBV DNA in blood or tissues with absence of HBsAg either with or without antibodies to hepatitis B core (anti-HBc) or hepatitis B surface (anti- HBs), outside the pre seroconversion window phase [10, 11]. Perpetual progress in molecular biology techniques has led to more preponderant apperception and diagnosis of OBI. The presence of OBI has been reported in sundry studies among different populations as in patients with chronic liver disorders or hepatocellular carcinoma in integration to salubrious blood donors [12]. Moreover, viral reactivation was tenacious following immunosuppressant situations and even through contingent transmission through transplantation and transfusion [13]. The present study was performed to study the presence of Occult Hepatitis B among Patients under hemodialysis and risk factors associated with this infection Zaki, J Virol Antivir Res 2014, 3:1 http://dx.doi.org/10.4172/2324-8955.1000118 Journal of Virology & Antiviral Research Research Article A SCITECHNOL JOURNAL All articles published in Journal of Virology & Antiviral Research are the property of SciTechnol, and is protected by copyright laws. Copyright © 2014, SciTechnol, All Rights Reserved.