Occult hepatitis B infection – unveiling clinical burden and new diagnostic strategies

The WHO has called for reducing 90% new HBV infections and 65% HBV-related mortality by 2030. The persistence of low-level virus replication in persons who cleared serum HBsAg is challenging. OBI misdiagnosis has emerged as a major obstacle for global HBV elimination. Efforts for unveiling OBI carriers are warranted, increasing clinical suspicion and expanding testing. New diagnostic tools, including more sensitive HBsAg and HBV-DNA tests and novel HBV-RNA and HBcrAg assays, may help unveil OBI carriers. Furthermore, point-of-care HBV-DNA assays will allow testing larger populations for OBI. New antivirals should target this form of hidden hepatitis B.