Transfusion Transmissible Infections in Blood Donors in the Province of Bié, Angola, during a 15-Year Follow-Up, Imply the Need for Pathogen Reduction Technologies

Transfusion transmissible infections (TTIs), caused by hepatitis B virus (HBV), human immunode-ficiency virus (HIV), hepatitis C virus (HCV), and syphilis, have a high global impact, especially in sub-Saharan Africa. We evaluated the trend of these infections over time in blood donors in Angola. A retrospective cross-sectional study was conducted among blood donors in Angola from 2005 to 2020. Additionally, frozen samples obtained from blood donors in 2007 were investigated to identify chronic HCV carriers and possible occult HBV infection (OBI). The overall prevalence of HBV, HCV, HIV, and syphilis was 8.5, 3, 2.1, and 4.4%, respectively, among 57,979 blood donors. HBV was predominant among male donors, while the remaining TTIs were predominant among women. Donors >50 years had a significantly high prevalence for all TTIs. Chronic HCV infection was ab-sent in 500 samples tested and OBI was present in 3%. Our results show the continued high prev-alence of TTIs among blood donors in Angola. Most infections showed a significantly low preva-lence in years with campaigns seeking voluntary blood donors, thus, reinforcing the importance of this type of donor to ensure safe blood. Africa, with a high prevalence of diverse pathogens, should consider cost-effective pathogen reduction technologies, once they are commercially accessible, to increase the availability of safe blood.

Molecular Epidemiology of Hepatitis B Virus Among HIV Co-Infected and Mono-Infected Cohorts in Northwest Ethiopia

Background Hepatitis B virus (HBV) infection is a particular concern in human immunodeficiency virus (HIV) infected individuals. In Ethiopia, detailed clinical and virological descriptions of HBV prevailing during HIV co-infection and symptomatic liver disease patients are lacking. The aim of this study was to investigate HBV virological characteristics from Ethiopian HBV/HIV co-infected and HBV mono-infected individuals. Methods A total of 4105 sera from HIV positive individuals, liver disease patients, and blood donors were screened serologically for HBV. The overlapping polymerase/surface genome region of HBV from 180 infected individuals was extracted, amplified, and sequenced for genotypic analysis. Results The HBsAg seroprevalence was detected 43% in liver disease patients, 8.4% in blood donors, and 6.7% in HIV/HBV co-infected individuals. The occult HBV prevalence was 3.7% in HIV/HBV co-infected individuals and 2.8% in blood donors with an overall prevalence rate of 3.4%. A phylogenetic analysis showed three HBV genotypes; A (61.1%), D (38.3%) and E (0.6%). Genotype A belongs to subtypes A1 (99.1%) and A9 (0.9%), but genotype D showed heterogeneous subtypes; D2 (63.8%) followed by D4 (21.7%), D1 (8.7%), D3 (4.3%), and D10 (1.4%). Conclusions The HIV/HBV co-infected individuals and blood donors showed lower HBsAg seroprevalence compared to liver diseases patients. Occult HBV prevalence showed no difference between HIV/HBV co-infected and blood donor groups. This study demonstrated predominance distribution of HBV subtypes A1 and D2 in northwest Ethiopia. The observed virological characteristics could contribute for evidence-based management of viral hepatitis in Ethiopia where antiretroviral therapy guidelines do not cater for viral hepatitis screening during HIV co-infection.

Hepatitis B Virus Reactivation upon Immunosuppression: Is There a Role for Hepatitis B Core-Related Antigen in Patients with Immune-Escape Mutants? A Case Report

The reactivation of hepatitis B virus (HBVr) in patients undergoing pharmacological immunosuppression is a potentially fatal clinical event that may occur in patients with overt or occult HBV infection. The risk of HBVr is mainly determined by the type of immunosuppressive therapy and the HBV serologic profile, with a higher risk in patients positive for the hepatitis B surface antigen (HBsAg), and a lower risk in HBsAg-negative/antibodies to core antigen-positive subjects. Notably, a considerable proportion of patients experiencing HBVr showed a high degree of variability of the HBV S gene, possibly leading to immune escape mutants. These mutations, usually in the “a-determinant” of the HBsAg, can cause diagnostic problems and consequently hamper the appropriate management strategy of patients at risk of HBVr. Here, we describe a case of HBVr in a patient with a diagnosis of chronic myeloid leukemia and a previous history of kidney transplant, providing evidence of the potential usefulness of hepatitis B core-related antigen measurement in patients with HBV immune-escape mutants at risk of viral reactivation.

Risk and Prevention of Hepatitis B Virus Reactivation during Immunosuppression for Non-Oncological Diseases

Reactivation of overt or occult HBV infection (HBVr) is a well-known, potentially life-threatening event which can occur during the course of immunosuppressive treatments. Although it has been described mainly in subjects receiving therapy for oncological or hematological diseases, the increasing use of immunosuppressant agents in non-oncological patients observed in recent years has raised concerns about the risk of reactivation in several other settings. However, few data can be found in the literature on the occurrence of HBVr in these populations, and few clear recommendations on its management have been defined. The present paper was written to provide an overview of the risk of HBV reactivation in non-neoplastic patients treated with immunosuppressive drugs, particularly for rheumatological, gastrointestinal, dermatological and neurological diseases, and for COVID-19 patients receiving immunomodulating agents; and to discuss the potential strategies for prevention and treatment of HBVr in these settings.

HIV, HCV and SARS-CoV-2: friends or foes? A case report

Data about co-infection of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), HIV, and hepatitis C virus (HCV) are still scarce. We describe a patient hospitalized for sore throat, fatigue, and myalgia with a personal history of HIV and occult HBV infection. His antiretroviral therapy included bictegravir/emtricitabine/tenofovir alafenamide. The nasopharyngeal swab was positive for SARS-CoV-2 and laboratory testing showed acute HCV. Antiretroviral therapy was continued, but no specific therapy for SARS-CoV-2 was started. After 4 weeks, the nasopharyngeal swab resulted negative for SARS-CoV-2 and biochemical tests revealed undetectable HCV RNA with normalization of transaminases. To the best of our knowledge, this is the first reported case of acute HCV in a patient with HIV and SARS-CoV-2 co-infection.

The frequency of detection of anti-HBc in blood donors from four regions of Russia

Introduction. Occult hepatitis B virus (HBV) revelation in HBV nuclear antigen testing is of particular importance to prevent transfusion infection.Aim — the identification of factors affecting the anti-HBc detection rate in donated transfusable blood components from different regions of Russia.Materials and methods. A cohort screening single-stage epidemiological study was conducted with 2,000 donor blood samples, 500 samples per each of four regions of the country, the Republics of Crimea (Simferopol) and Sakha (Yakutia), the cities of Saransk and Orenburg. Data on 968 blood samples from the National Research Center for Hematology’s donor bank were used as reference. The testing targeted HBV nuclear antigen antibodies. Positive donated blood samples were additionally tested for IgM and virus surface antigen antibodies using Abbott and Vector-Best commercial reagent kits.Results. Donor demographic profiles differed insignificantly across members of the Russian Federation. Males predominated among the donors (69.6 %). Anti-HBc was detected in 219 of 2,000 samples examined (10.9 %). The donor blood sample anti-HBc detection rate ranged from 6.0 to 21.6 %, depending on the region. Anti-HBc-positive proportions in Orenburg, Crimea, Mordovia and Sakha comprised 8.2, 8.0, 6.0 and 21.6 %, respectively (p < 0.01). First-time donors had anti-HBc in 8.06, regular donors — in 11.29 % cases. The anti-HBc detection rate varied with donor’s age, being zero or near 1 % in 20-yo or younger people. Acute HBV antibodies had zero rate in Orenburg at zero or low-titre (< 100 mIU/mL) protective antibodies; 31 total samples, 15 low-titre and 16 negative for protective antibodies. In Simferopol, acute phase antibodies were negative in 7 blood samples containing high-titre protective antibodies (> 100 mIU/mL) and in 5.0 % samples with their low or zero levels. In Yakutian donors, acute phase antibodies were revealed only at protective antibodies negative. In Saransk, this marker was equal-proportion at zero and high-titre protective antibodies (3.3 % each).Conclusion. Transfusion component procurement from younger donors should be prioritised as enhancing haemotransfusion viral safety. Positive occult HBV tests were less common in regions with low HBV incidence.

The association between hepatitis B virus mutations and the risk of liver disease and hepatocellular carcinoma

: Hepatitis B virus [HBV], the best-described hepadnavirus, distributed all around the world and may lead to chronic and acute liver disease, cirrhosis, and hepatocellular carcinoma. Despite the advancement in treatment against HBV, an error-prone reverse transcriptase which is require for HBV replication as well as host immune pressure lead to constant evolution and emergence of genotypes, sub-genotypes and mutant viruses; so, HBV will be remained as a major healthcare problem around the world. This review article mainly focuses on the HBV mutations which correlated to occult HBV infection, Immune scape, vaccine failure and eventually liver cirrhosis and HCC. Current study indicated that preS/S region mutations are related to vaccine failure, immune escape, occult HBV infection and the occurrence of HCC. Whereas, P region Mutations may lead to drug resistance to NA antivirals. PreC/C region mutations are associated to HBeAg negativity, immune escape, and persistent hepatitis. Moreover, X region Mutations play an important role in HCC development.

Endemic HBV among hospital in-patients in Bangladesh, including evidence of occult infection

Bangladesh is one of the top-ten most heavily burdened countries for viral hepatitis, with hepatitis B (HBV) infections responsible for the majority of cases. Recombinant and occult HBV infections (OBI) have been reported previously in the region. We investigated an adult fever cohort (n=201) recruited in Dhaka, to determine the prevalence of HBV and OBI. A target-enrichment deep sequencing pipeline was applied to samples with HBV DNA >3.0 log10 IU ml−1. HBV infection was present in 16/201 (8 %), among whom 3/16 (19 %) were defined as OBI (HBsAg-negative but detectable HBV DNA). Whole genome deep sequences (WGS) were obtained for four cases, identifying genotypes A, C and D. One OBI case had sufficient DNA for sequencing, revealing multiple polymorphisms in the surface gene that may contribute to the occult phenotype. We identified mutations associated with nucleos(t)ide analogue resistance in 3/4 samples sequenced, although the clinical significance in this cohort is unknown. The high prevalence of HBV in this setting illustrates the importance of opportunistic clinical screening and DNA testing of transfusion products to minimise OBI transmission. WGS can inform understanding of diverse disease phenotypes, supporting progress towards international targets for HBV elimination.