Scientific letter
Study of hidden hepatitis B in African immigrant people without data of liver disease
Estudio de hepatitis B oculta en población inmigrante africana sin datos de hepatopatía
José Ángel Cuenca-Gómez
, M. Teresa Cabezas-Fernández, Manuel Jesús Soriano-Pérez, Joaquín Salas-Coronas
Corresponding author
Unidad de Medicina Tropical, Agencia Sanitaria Hospital de Poniente, El Ejido, Almería, Spain
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Teresa Cabezas-Fernández, Manuel Jesús Soriano-Pérez, Joaquín Salas-Coronas" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José Ángel" "apellidos" => "Cuenca-Gómez" "email" => array:1 [ 0 => "jacuencag@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "Cabezas-Fernández" ] 2 => array:2 [ "nombre" => "Manuel Jesús" "apellidos" => "Soriano-Pérez" ] 3 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Salas-Coronas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Medicina Tropical, Agencia Sanitaria Hospital de Poniente, El Ejido, Almería, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de hepatitis B oculta en población inmigrante africana sin datos de hepatopatía" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Occult Hepatitis B (OHB) is defined as the presence of viral DNA in the liver (with or without viral DNA detectable in serum) in patients with negative HBsAg. Normally, these patients only have the AcHBc hepatic marker, although, in some cases, they may also show the AcHBs marker.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The province of Almeria has an elevated number of immigrants from Sub-Saharan Africa, a region presenting a high prevalence of hepatitis B virus (HBV) positive markers.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Recently published scientific research indicates the presence of OHB among immigrants with negative HBsAg and positive AcHBc and/or AcHBs.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> The main goal pursued by this work was to study the prevalence of this disease in African immigrant patients not infected with the human immunodeficiency virus (HIV), without any clinical or analytical data indicating hepatopathy, and with positive AcHBc as the only HBV marker.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study is a prospective observational study, including immigrants from Sub-Saharan Africa seen during 2011 at the Tropical Medicine Unit from the Hospital del Poniente hospital (El Ejido, Almeria) that met the abovementioned criteria and agreed to participate. In each case, the DNA viral load detection was made by means of the qualitative PCR method (nested PCR, HBsAg-Pol region) with 180<span class="elsevierStyleHsp" style=""></span>IU/ml sensitivity. A total of 16 of said patients were also treated using <span class="elsevierStyleItalic">real time</span> PCR (RT-PCR) methods, linear range 20<span class="elsevierStyleHsp" style=""></span>UI/ml (COBAS<span class="elsevierStyleSup">®</span> AmpliPrep/COBAS<span class="elsevierStyleSup">®</span> TaqMan<span class="elsevierStyleSup">®</span> HBV Test, v2.0).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 40 patients were included, 35 of which were male (87.5%). The average age was 33.98 years (ranging 19–68). The most frequent countries of origin were: Mali (12; 30%) and Guinea Bissau (10; 25%). Seventeen patients (42.5%) recognized hepatitis B risk factors, such as punctures (12; 30%) or high-risk sexual relations (8; 20%). Even though a normal abdominal echography does not rule out possible hepatopathy, echography was done on 16 patients for reasons not concerning this study, without signs of hepatopathy. The DNA HBV study, both using the PCR method (nested PCR, HBsAg-Pol region) applied to all 40 patients, as well as the RT-PCR method applied to 16 of them, turned out to be negative for the entirety of the subjects included in the study.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The fact that no OHB cases were detected among the subjects participating in this study contrasts with other studies also conducted on immigrant populations, where the prevalence of this disease ranges between 3 and 4.5%.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> A possible explanation accounting for these results might be the fact that that these studies included patients infected by HIV. Besides, the Chadwick et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> study also included patients with high transaminase levels.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Spain, we have found 4 OHB studies, but the characteristics of the subjects included in those studies differ from those of the subjects participating in this study. Two of them were conducted on a group of predominantly non-immigrant patients infected with HIV, with a resulting OHB prevalence of 0.7% and 2.5%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> Another study was conducted on serological samples from blood donors in Madrid, with an OHB prevalence observed every 29,482.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> The last study was conducted on paediatric patients infected with HIV, but in this case, no serological HBV DNA trace was detected in any of the participating subjects.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">There are other studies on a global level, but the characteristics of the patients are very heterogeneous, making it difficult to compare results. Raimondo et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> noticed an OHB prevalence of 16.3% in Italian patients with similar characteristics to those in this study, although the HBV DNA detection was done directly from hepatic tissue samples.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The importance of this study resides in the fact that Spain barely has specific studies concerning OHB among immigrants, despite the fact that many of them come from areas with a high HBV infection endemicity, such as, in our case, Sub-Saharan Africa. The presence of a high prevalence of this disease in our means could suppose, in addition to a public health problem, an overload of costs for the National System of Health.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Our study has been conceived as a preliminary approach to the disease in this population group. The main limitation observed is the small size of the study group. Other limitations are the fact that the HBV DNA detection was completed only in peripheral blood and not in liver tissue, and that the ultrasensitive PCR (RT-PC) could only be conducted in 16 patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Assessing the results obtained, we could safely conclude that in our region, the OHB study conducted on African immigrant subjects with positive AcHBc as their only hepatitis B marker and without hepatopathy data, does not seem to be cost-effective, thus we discourage routine screening. However, new studies are necessary in order to confirm this statement.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study has been financed with funds from the research project “Proyecto salud e inmigración” (“Health and Immigration Project”) (Ref. 2011-2-1), subsidised by the Migrations and Intercultural Relations Training Centre (CEMyRI), in collaboration with the <span class="elsevierStyleGrantSponsor" id="gs1">University of Almeria</span>, the <span class="elsevierStyleGrantSponsor" id="gs2">Ministry of Labour and Immigration</span> and the <span class="elsevierStyleGrantSponsor" id="gs3">CTS-582 Group of Investigation</span>.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cuenca-Gómez JÁ, Cabezas-Fernández MT, Soriano-Pérez MJ, Salas-Coronas J. Estudio de hepatitis B oculta en población inmigrante africana sin datos de hepatopatía. Med Clin (Barc). 2015;144:42–43.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Statements from the Taormina expert meeting on occult hepatitis B virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Raimondo" 1 => "J.P. Allain" 2 => "M.R. Brunetto" 3 => "M.A. Buendia" 4 => "D.S. Chen" 5 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 1 | 3 |
| 2017 October | 2 | 2 | 4 |
| 2017 September | 11 | 1 | 12 |
| 2017 August | 17 | 2 | 19 |
| 2017 July | 8 | 1 | 9 |
| 2017 June | 23 | 3 | 26 |
| 2017 May | 8 | 1 | 9 |
| 2017 April | 5 | 2 | 7 |
| 2017 March | 9 | 2 | 11 |
| 2017 February | 8 | 1 | 9 |
| 2017 January | 4 | 1 | 5 |
| 2015 November | 1 | 0 | 1 |
