ArticleScientific reports2026
Occult HBV among anti-HBc-reactive blood donors in Colombia: low HBsAg prevalence, genotype F3, and small-S variation relevant to HBsAg detectability.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeOccult hepatitis B infection (OBI) can sustain residual transfusion risk because HBV DNA may persist at very low levels while HBsAg remains undetectable by routine serology. We assessed OBI among anti-HBc-reactive, HBsAg-negative (anti-HBc+/HBsAg-) donors in Bucaramanga, Colombia and characterized small-S variation within genotype F3.
methodsIn 2021, we analyzed 61,188 donations in three licensed blood banks using routine serology. From anti-HBc+/HBsAg- donations, 219 randomly selected sera underwent nested PCR targeting the small-S/reverse-transcriptase overlap, followed by Sanger sequencing. Genotyping and phylogeny used a curated 960-nt small-S fragment. Associations with OBI were estimated by logistic regression.
resultsHBsAg reactivity was 0.21% and anti-HBc prevalence was 1.77%. OBI occurred in 16/219 anti-HBc+/HBsAg- donations (7.3%; 95% CI, 4.5-11.5), approximately 130 per 100,000 donations (95% CI, 80-204). Among the 16 OBI cases, 12 were anti-HBs reactive. Sex, age, and anti-HBs were not associated with OBI after adjustment. All sequences clustered within genotype F3. Small-S amino acid variation at positions previously linked to altered HBsAg detectability was observed in 11/16 (68.8%): A166G (5/16) outside "a"; "a" substitutions L127R, K141N, N146Y, C147S; variants at the pre-"a" boundary K122R/T123A; loop-proximal cysteine changes C149S/C149F and S117C; stop codons W156 and L216*; additional MHR changes included V106D, T118S, I150V, P151R, I152S, K160I.
conclusionsAll OBI cases belonged to genotype F3 and showed small-S variants at positions previously associated with HBsAg detectability, which may contribute to reduced detection rather than classical antigenic escape. Among anti-HBc+/HBsAg- donations, targeted NAT identified donors with detectable HBV DNA within this serologic profile that routine screening alone could not resolve, indicating a residual risk that may be reduced through selective NAT where universal implementation is not feasible.
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