Occult Hepatitis B Infection in Chronic Hemodialysis Patients: Current Concepts and Strategy

The prevalence of end-stage renal disease has increased dramatically in developing countries, and this has been accompanied by the widespread utilization of chronic hemodialysis in its management prior to kidney transplantation. Within this group, the interjection of hepatitis B virus (HBV) infection represents a significant co-morbidity event that has led to several outbreaks of hepatitis B. Occult hepatitis B (OHB) is a variant of conventional hepatitis B that is manifested by the presence of HBV DNA in blood and/or tissue in the absence of hepatitis B surface antigen (HBsAg). It is postulated that its impact on chronic hemodialysis patients also might be of importance. Unfortunately, there are only a limited number of published studies on this topic and, in most cases, only prevalence data are reported without descriptions of histopathology or outcome measurements. In this paper, we have reviewed this information. Based on the scarcity of available data, HBV DNA assessment with highly sensitive assays might be informative in this target population, especially among those hemodialysis patients who present with isolated antibodies to the hepatitis B core antigen (anti-HBc) or who are hepatitis C virus (HCV) RNA positive, since HCV coinfection appears to worsen the outcome. Clearly, more precise studies need to be performed to answer questions concerning the impact of OHB in chronic hemodialysis patients.