《Occult Hepatitis B Infection 隐匿性乙型肝炎感染》由14位国内外在隐匿性乙型肝炎感染（OBI）研究领域的**专家**研究进展构成。内容涉及中国乙肝疫苗接种者OBI感染情况调查；世界范围内的OBI流行病学调查；抗-HBc检测在OBI中的应用；OBI和HCV合并感染情况；OBI的临床意义；OBI的发生是否是肝细胞癌的一个危险因素；HBsAg抗原突变和其临床意义及OBI与血液安全的相关性等议题。
目錄：
Contents
Natural history of occult hepatitis B virus infection（1-21）
Yang HI， Liu J， Lee MH， Hu HH， Chang CL， Chen CJ
Breakthrough infection and OBI: different?（22-31）
Zeng P， Norris PJ
Global epidemiology of occult HBV infection（32-48）
Allain JP
OBI and HBV replication（49-69）
Locarnini S
The woodchuck model of occult hepatitis B virus infection（70-89）
Michalak TI
Biological and clinical significance of hepatitis B virus RNA splicing：
a role for spliced variants in occult infection?（90-107）
Candotti D， Allain JP
Mechanisms responsible for OBI（108-123）
Pollicino T
PreSS gene mutations of HBV and their clinical implications（124-133）
Wang JZ， Zhu B， Lu MJ， Yang DL
Cellular immunity and occult HBV infection（135-144）
Ferrari C， Barili V， Rossi M， Boni C， Fisicaro P
Occult hepatitis B infection in vaccinated children145-161
Poortahmasebi V， Alavian SM， Jazayeri SM
Occult hepatitis B virus infection in the vaccinated Chinese population
（162-177）
Li CY， Fu YS， Li TT， Allain JP
Clinical implication of occult hepatitis B Infection（178-189）
Yuen MF
Occult hepatitis B infection and anti-HBc testing（190-209）
Satake MOccult HBV infection and blood safety: a review（210-232）
Lelie N
Unresolved questions regarding OBI raised during the Guangzhou
symposium（233）
Allain JP
內容試閱：
1Natural history of occult hepatitis B virus infection
Hwai-I Yang，1，2 Jessica Liu，1 Mei-Hsuan Lee，2 Hui-Han Hu，1 Chia-Ling Chang，1 Chien-Jen Chen1，31 Genomics Research Center，Academia Sinica，Taipei，Taiwan，China2 Institute of Clinical Medicine，National Yang-Ming University，Taipei，Taiwan，China3 Graduate Institute of Epidemiology and Preventive Medicine，National Taiwan University，Taipei，Taiwan，China
Summary
From a population point of view，individuals with occult hepatitis B virus infection （OBI） may originate from various past histories of hepatitis B virus （HBV） infection OBI patients may result from those who recovered from acute HBV infection，while some of them may have become occult after decades of chronic infection
From literature it has been demonstrated HBV can persist as an occult infection for several years after acute，self-limited hepatitis B Patients who recovered from acute hepatitis B may not result in complete virus elimination，but rather the immune system keeps the virus at very low levels Studies of spontaneous seroclearance of hepatitis B surface antigen （HBsAg） after chronic hepatitis B clearly demonstrated that a substantial number of OBI subjects could be discovered at or shortly after HBsAg seroclearance The prevalence of OBI was time-dependent，which declined gradually during follow-up HBV DNA levels in these OBI patients were usually low Most patients who underwent HBsAg seroclearance still harbored HBV inside the liver after HBsAg seroclearance，although the virus was low replicative and transcriptionally inactive. Definitive data regarding the association between OBI and chronic liver disease including hepatocellular carcinoma （HCC） is still lacking There is no evidence that patients with persistently low levels of HBV DNA after recovery from acute hepatitis B have increased risks of cirrhosis or HCC Many of the past studies of the association between OBI and chronic liver disease （and HCC） were limited by the cross-sectional designs，small sample sizes，and using HCV-infected patients More studies using cohort or nested case-control study designs with large sample sizes and high-quality laboratory methods are needed，and subjects who are not infected with HCV should be the prioritized study target Community-based studies are suggested in order to know the true prevalence of OBI and its impact on disease progression in the general population Future studies should examine the OBI associated risk according to different viral loads Both OBI and metabolic factors should be carefully investigated in order to figure out the independent and joint impact of these factors on liver diseases
Introduction
Hepatitis B virus （HBV） is a human carcinogen and chronic infection with the virus remains a major global health problem［1］ Although effective vaccines have been available since 1982，a third of the worlds population has been infected by this virus More than 350 million people have progressed to chronic infection ［2］，and are at extremely high risk of developing end-stage liver diseases such as cirrhosis，liver decompensation，and hepatocellular carcinoma （HCC） Unfortunately，the majority of patients resides in the Asia-Pacific and sub-Saharan Africa regions，where the infection is acquired perinatally or horizontally at a young age
Screening for HBV infection is most often done through the detection of hepatitis B surface antigen （HBsAg） in the serum，and the persistence of HBsAg for more than 6 months is used to define chronic HBV infection This antigen may not be present for a lifetime，it can sometimes be cleared spontaneously during late stages of infection，which is usually considered the eradication of HBV infection However，with the emergence of highly sensitive HBV DNA polymerase chain reaction （PCR） assays，some patients can be identified as having occult HBV infection （OBI） OBI is indicated by the presence of the HBV DNA in the blood or liver without the detection of HBsAg［3，4］，which may be related to the long-term persistence of HBV DNA reservoirs in hepatocytes in the form of covalently-closed-circular DNA （cccDNA） OBI carriers may thus be an unseen source of HBV transmission through blood transfusions and orthotopic liver transplantation Under immunosuppressive treatment，HBV reactivation might also occur ［5，6］ In addition，occult hepatitis B infection may also contribute to the development of hepatocellular carcinoma （HCC） However，the exact role of OBI in current clinical practice remains unclear
Natural history of HBV infection
Hepatitis B virus infection may be either acute （self-limited） or chronic （persistent），which highly depends on whether a person is infected as an infant，a child，or an adult About 90% of infants infected with HBV will become chronically infected Between 25% to 30% of children who are infected with HBV at ages 0 to 5 will remain chronically infected with the virus In contrast，nearly 95% of adults recover completely from HBV infection and do no
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