随着检测技术的完善、特别是核酸检测灵敏度的提高，人们在临床实践过程中发现，有些个体的血清用商品化的试剂盒不能检测出HBsAg，但其肝脏或血液中却可以检测出低水平的HBV DNA，这一现象称为隐匿性HBV感染。隐匿性HBV感染临床诊断较困难，但这种隐匿感染却可使疾病慢性进展，最终导致肝硬化、甚至肝细胞癌的发生。
日前，在APASL 2020肝纤维化专场，美国肝病研究学会（AASLD）2017主席、美国密歇根大学Anna Lok教授进行了“Controversies and New Perspectives in Occult Hepatitis B Infection（隐匿性乙型肝炎感染的争议与新观点）”报告，引发广泛关注。会后，《国际肝病》前方记者有幸邀请到Anna Lok教授接受采访，请她谈谈隐匿性乙型肝炎感染那些事。具体内容报道如下。
Anna Lok教授
《国际肝病》：目前，隐蔽性HBV感染的流行率如何?
Anna Lok教授：正如我在我报告中提到的，这一数值是高度可变的。HBV的高感染流行率是隐匿性乙型肝炎感染存在的基础，患病率的确定取决于流行病学调查所在国家的人口情况、疾病的定义、使用的方法以及敏感性和特异性。因此，目前尚无统一答案。
原文呈现：
: What is the prevalence of occult hepatitis B infection?
Dr Lok: As I mentioned in my talk, it is highly variable depending on the study population, the country in which the study is done, and the definition, sensitivity and specificity of the methods used. There is no single answer.
《国际肝病》：哪些患者应该考虑隐匿性HBV感染的可能性？
Anna Lok教授：对于肝病患者，尤其是肝癌患者，如果没有确定的潜在病因，可以考虑隐匿性乙型肝炎感染的可能，应该进一步寻找证据。此外，对于接受过献血的患者，如果感染乙型肝炎，应该献血者为隐性感染者的可能。
原文呈现：
: For which patients should the possibility of occult hepatitis B infection be considered?
Dr Lok: If you have a patient with liver cancer, and there isn’t an underlying etiology, you might consider occult hepatitis B infection and should look for evidence. So, in patients with liver disease, and particularly liver cancer, where there is no underlying etiology that you can identify, look for occult hepatitis B infection. Certainly in the blood donor setting, if you have transmission of hepatitis B infection, you have to look at the possibilities of how that slipped through. It may be because the donor had occult hepatitis B.
《国际肝病》：对于血清HBV DNA检测不出的患者，如何诊断隐匿性乙肝感染？
Anna Lok教授：尽管依赖于肝组织的rcDNA或cccDNA的诊断准确可靠，但由于肝穿是有创检查，而隐匿性乙型肝炎人群症状较轻，在临床实践过程中难以广泛通过肝穿来诊断。因此，在大规模研究中，依靠检测乙肝核心抗体确诊更为常见。
原文呈现：
: How do we diagnose occult hepatitis B infection in patients with undetectable HBV DNA in their serum?
Dr Lok: Ideally, if you have access to liver tissue, which most us don’t. More commonly, for large-scale study, we rely on the detection of hepatitis B core antibody.
《国际肝病》：哪些隐匿性乙肝患者应该考虑预防性抗病毒治疗或抗病毒治疗？
Anna Lok教授：关于预防性抗病毒治疗，隐匿性乙型肝炎者不需要进行抗病毒治疗。但如果患者需要接受免疫抑制治疗时，应该考虑预防性抗病毒治疗。
原文呈现：
: For which patients with occult hepatitis B should prophylactic antiviral therapy or antiviral therapy be considered?
Dr Lok: They do not need to be put on antiviral therapy. However, if they need to receive immunosuppressive therapy, then prophylactic antiviral therapy should be considered. The reason for considering prophylactic antivirals is because for bone marrow transplantation, very potent immunosuppressive therapy is required, such as anti-CD20.