Atypical hepatitis B surface antigen escape mutations in an HIV-positive patient in South Africa.

Authors

Menzi B Nkosi, Marije van Schalkwyk, Tongai G Maponga, Yoliswa Z Chili, Devon Muir, Paula R Delport, Susan S Hugo, Zahiera Ismail, Jantjie Taljaard, Gert U van Zyl, Wolfgang Preiser

Published in

Southern African journal of infectious diseases. Volume 41. Issue 1. Pages 818. Epub Jun 30, 2026.

Abstract

A 44-year-old woman with human immunodeficiency virus (HIV), chronic kidney disease and chronic diarrhoea presented with worsening gastrointestinal symptoms and renal impairment. Despite reported adherence, she had HIV viraemia and atypical hepatitis B serology (absence of hepatitis B core antibody and co-existence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody) with high hepatitis B virus DNA. Whole genome sequencing of hepatitis B virus was performed using Oxford Nanopore Technologies sequencing on the Oxford Nanopore Technologies GridION (ONT, Oxford, United Kingdom). Genotype A infection with HBsAg immune escape mutations D144G/G145E was identified, without drug-resistance mutations.
Findings are most consistent with hepatitis B virus reactivation following prior natural infection and subsequent loss of immune control.

PMID:
42428788
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.

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