Occult hepatitis B virus infection in Egyptian hemodialysis patients with or without hepatitis C virus infection

Hisham Ismail¹*, Mohamed Soliman², Nahed Ismail^3
1Department of Molecular Diagnosis, GEBR Institute, ²Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; ³Department of Pathology and Department of Microbiology and Immunology, Meharry Medical College, Nashville, Tennessee, USA *Current affiliation: College of Medicine, Qassim University, Saudi Arabia

Abstract: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are frequent in patients with end-stage renal disease who are on maintenance hemodialysis. There are limited data about the prevalence of occult HBV infection in patients on long-term hemodialysis. Occult HBV is defined as positive HBV DNA in the blood in the absence of hepatitis B surface ­antigen in the serum. In this study, we determined the prevalence of occult HBV in hemodialysis patients with or without HCV infection. The study included 116 patients with end-stage renal disease on chronic hemodialysis, of whom 64 patients were HCV RNA positive (Group 1), and 52 were HCV RNA negative (Group 2). We found that four of 64 (6.3%) hemodialysis patients with HCV infection (Group 1) had occult HBV, while only two of 52 (3.8%) hemodialysis patients without HCV (Group 2) had occult HBV. We then examined whether gender-matched ­hemodialysis patients with positive HBV DNA in the two hemodialysis groups differed in specific parameters, ie, age, degree of liver dysfunction, and presence of ­coinfection with schistosomiasis, a common parasitic infection of the liver. We found no significant difference between the groups having positive HBV DNA with regard to serum levels of liver enzymes, aspartate transaminase, albumin, and hepatitis B core antigen (P > 0.05). However, we detected significantly higher levels of alanine transaminase, a prolonged duration of hemodialysis, and higher levels of schistosomal antibodies in Group 1 than in Group 2. Interestingly, we found that the presence of schistosomal antibodies, history of past blood transfusion, and longer hemodialysis ­duration could distinguish patients with occult HBV infection from those with HBV DNA negative infection in hemodialysis patients. In conclusion, the prevalence of occult HBV in chronic hemodialysis patients is low, and does not significantly differ between hemodialysis patients with or without HCV coinfection.

Keywords: occult hepatitis B virus, hepatitis C virus, schistosomiasis, hemodialysis