Diagnosis and Management of Occult Hepatitis B Infection

Occult hepatitis B infection refers to the presence of replication-competent hepatitis B virus despite the lack of hepatitis B surface antigen due to epigenetic or immune control. Risk factors for occult hepatitis B infection include sex work, blood transfusion, hemodialysis, and liver transplantation. Historically, the recognition of occult hepatitis B infection has been important in preventing reactivation of hepatitis B infection and mortality in those receiving treatment for HIV and hepatitis C virus along with those receiving immunosuppressive therapy. Recognition of occult hepatitis B infection has increased and continues to evolve with improved detection methods in both serum and liver tissue to identify HBV DNA. Advancements in the understanding of genetic variations of hepatitis B have also contributed to the differentiation of overt versus occult hepatitis B infection. More recent research has contributed to the debate that occult hepatitis B infection may play a role in clinical outcomes such as chronic liver disease and hepatocellular carcinoma. With enhanced awareness of occult hepatitis B and improved methods for detection of HBV DNA and hepatitis B surface antigen, future studies understanding the natural history will shape policy regarding therapeutics and preventive strategies to prevent occult hepatitis B–related morbidity and mortality.