title: Occult hepatitis B virus infection as a cause of cirrhosis of liver in a region with intermediate endemicity.
abstract: BACKGROUND
  Serological tests may fail to identify hepatitis B virus (HBV) infection as a cause of liver cirrhosis in a proportion of patients. The frequency of such occult infection in regions with intermediate HBV endemicity is not known. Such cases may be diagnosed by incremental testing for IgG anti-HBc, serum HBV DNA, and HBV DNA in liver tissue.
  
  
  METHODS
  We tested sera of 111 patients with cirrhosis, including 39 with history of significant alcohol ingestion, for HBsAg, anti-HBc and serum HBV DNA. In addition, in a subset of 14 patients, HBV DNA was looked for in liver tissue.
  
  
  RESULTS
  On HBsAg and anti-HBc testing, 66 patients had HBV infection. Serum HBV DNA testing identified HBV infection in 13 additional cases. Of 18 patients labeled as 'cryptogenic' on serological testing, HBV DNA was detected in the serum in 7 patients. Of 14 patients in whom paired liver tissue and serum specimens were tested, 4 additional patients with HBV infection were detected after liver biopsy analysis.
  
  
  CONCLUSIONS
  Serological tests for HBsAg and anti-HBc antibody are insensitive in identifying HBV infection in patients with liver cirrhosis. HBV DNA testing in serum and liver can help in establishing HBV infection as etiology, either alone or in addition to another cause.
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014.
authors.forename: Neeti
authors.initials: N
authors.lastname: Agarwal
authors.forename: Sita
authors.initials: S
authors.lastname: Naik
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Harjeet
authors.initials: H
authors.lastname: Singh
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Somani
authors.forename: Dinesh
authors.initials: D
authors.lastname: Kini
authors.forename: R
authors.initials: R
authors.lastname: Pandey
authors.forename: Gourdas
authors.initials: G
authors.lastname: Choudhuri
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Saraswat
authors.forename: Subhash R
authors.initials: SR
authors.lastname: Naik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004279:DNA, Viral / Q000097:blood; D019353:Endemic Diseases; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D006511:Hepatitis B Antigens / Q000097:blood; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007194:India / Q000453:epidemiology; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged
chemical_list: D004279:DNA, Viral; D006508:Hepatitis Antibodies; D006511:Hepatitis B Antigens