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We read with great interest the paper by Candotti et al and the commentary by Locarnini and Raimondo.1 2 Occult hepatitis B virus (HBV) infection (OBI) poses a potential risk of viral reactivation and transmission in several aspects of clinical practices.3–7 Candotti et al confirmed the HBV transfusion transmission from OBI patients who had undetectable HBV DNA measured by the very sensitive nucleic acid testing (NAT). The infectious HBV produced from the intrahepatic persistent and replication-competent covalently closed circular (ccc) DNA is probably beyond the detection limit (3.4 IU/mL) of current NAT. The authors estimated the HBV infectious dose by transfusion could be as low as 3 IU of HBV DNA. They, thus, suggested that the development of ultrasensitive NAT (detection limit of 0.15 IU/mL) and …
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