Occult hepatitis B virus infection and its demographic and clinical determinants among blood donors in Saudi Arabia: A retrospective cross-sectional study.

ObjectiveOccult hepatitis B virus infection, characterized by the presence of hepatitis B virus DNA in the absence of detectable hepatitis B surface antigen, poses a significant risk to blood donation safety. This study aimed to determine the prevalence of occult hepatitis B virus infection and identify demographic and clinical predictors among blood donors in Saudi Arabia who were negative for hepatitis B surface antigen.MethodsA retrospective cross-sectional study was conducted using donor records to evaluate hepatitis B virus and other transfusion-transmissible infection markers. Demographic data were extracted, and multivariable logistic regression was performed to identify predictors of hepatitis B core antibody and hepatitis B virus DNA positivity.ResultsAmong the 49,502 donors negative for hepatitis B surface antigen, 27 had occult hepatitis B virus infection, representing a prevalence of 0.054%. Occult hepatitis B virus infection was more frequent among donors aged 31-40 and >51 years and was significantly associated with non-Saudi nationality, Middle Eastern and Asian origin, and syphilis coinfection. Syphilis was also significantly associated with prior hepatitis B virus exposure, as indicated by hepatitis B core antibody positivity. Notably, 5 of the 27 patients with occult hepatitis B virus infection (18.5%) were negative for hepatitis B core antibody, indicating that these cases would have been missed using serological screening alone.ConclusionThe prevalence of occult hepatitis B virus infection among blood donors in Saudi Arabia is low but clinically relevant. These findings underscore the limitations of serological screening alone and support the incorporation of nucleic acid testing to enhance transfusion safety.