Globally, 350 million people are chronically infected with hepatitis B virus (HBV) - the world's leading cause of cirrhosis and hepatocellular carcinoma (HCC). Chronic HBV infection is characterized by the presence of hepatitis B surface antigen (HBsAg) in the serum. In contrast, occult HBV infection (O-HBV) is defined as low level HBV replication in the absence of detectable circulating HBsAg. The transmissibility of O-HBV and the subsequent establishment of chronic HBV infection are well documented in humans and in primates. Moreover, O-HBV is associated with advanced liver fibrosis, reduced response to interferon therapy, the development of HCC, and increased liver enzyme levels. In HIV-positive cohorts, the prevalence of O-HBV infection is significantly elevated. In South Africa, both HIV and HBV are endemic, and HIV co-infection is a major risk factor for O-HBV infection. Moreover, treatment resistance mutations in the HBV Polymerase (P) gene - which overlaps with the Surface (S) gene - are common in South Africa - even among treatment-naove individuals - and may also impact HBsAg expression. Only a small number of studies evaluated the potential mechanism(s) for this lack of HBsAg detection in vitro. Major limitations to characterizing O-HBV infection include 1) the lack of sensitive quantitative assays for HBV DNA, and 2) the limited ability to identify and characterize mutations that are associated with O-HBV in the context of full-length, replication-competent genomes. Fortunately, highly sensitive, cost effective real-time PCR assays for HBV DNA quantification - such as that developed within our lab - are now available. Moreover, a novel method for efficient amplification of whole HBV genomes that also permits rapid functional analysis has been developed.
The aims of this application are to determine the effects of S and P gene mutations associated with O-HBV infection on HBsAg synthesis/retention/secretion and HBV replication in hepatocytes using full-length, replication-competent HBV expression vectors. The identification and characterization of O-HBV mutations in vivo that are not detected using current HBV screening assays and the development of in vitro assays to evaluate the mechanism(s) underlying the lack of HBsAg detection would improve future diagnostic sensitivity for O-HBV infection, limit secondary transmission of HBV, provide critical information on treatment options for O-HBV, and improve our understanding of how HBV replication contributes to the development of HCC.

Public Health Relevance

Chronic liver disease is a major cause of morbidity and mortality in HIV-positive individuals. In South Africa, where both HBV and HIV are endemic, HIV is a significant risk factor for occult HBV - defined as detectable HBV DNA in the absence of serum HBV surface antigen detection. The proposed studies will examine the epidemiologic characteristics and virologic mechanisms for this lack of surface antigen detection in this endemic setting and provide a framework for future in vivo and in vitro studies of occult HBV infection that could ultimately lead to improved diagnostic sensitivity for HBV infection and limit secondary infections.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Sharp, Gerald B
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Cincinnati
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
Powell, Eleanor A; Boyce, Ceejay L; Gededzha, Maemu P et al. (2016) Functional analysis of 'a' determinant mutations associated with occult HBV in HIV-positive South Africans. J Gen Virol 97:1615-24
Powell, Eleanor A; Razeghi, Sanam; Zucker, Stephen et al. (2016) Occult Hepatitis B Virus Infection in a Previously Vaccinated Injection Drug User. Hepat Mon 16:e34758
Amponsah-Dacosta, Edina; Lebelo, Ramokone L; Rakgole, J Nare et al. (2015) Hepatitis B virus infection in post-vaccination South Africa: occult HBV infection and circulating surface gene variants. J Clin Virol 63:12-7
Powell, Eleanor A; Gededzha, Maemu P; Rentz, Michael et al. (2015) Mutations associated with occult hepatitis B in HIV-positive South Africans. J Med Virol 87:388-400
Mayaphi, Simnikiwe H; Martin, Desmond J; Mphahlele, M Jeffrey et al. (2013) Variability of the preC/C region of hepatitis B virus genotype A from a South African cohort predominantly infected with HIV. J Med Virol 85:1883-92