title: Reactivation of an occult hepatitis B virus escape mutant in an anti-HBs positive, anti-HBc negative lymphoma patient.
abstract: BACKGROUND
  Hepatitis B virus (HBV) often persists after resolution, but its replication is suppressed by antiviral T cells. Immunosuppressive treatment may lead to viral reactivation and severe hepatitis. Early antiviral therapy prevents reactivation but some occult HBV infections are not easily detectable.
  
  
  RESULTS
  Here we describe a patient with a progressive non-Hodgkin lymphoma who had probably not been vaccinated against HBV and, before immunosuppression, showed antibodies (anti-HBs) against the viral surface antigen (HBsAg) as the only possible marker of occult HBV infection. Under immunosuppression he developed viremia (>10(8)copies/mL). The virus exhibited three S gene mutations (L109R, C137W, G145R) which led to false negative HBsAg results and diminished binding of vaccine-induced anti-HBs.
  
  
  CONCLUSIONS
  Reliable screening and monitoring of severely immunosuppressed patients for HBV should include, in addition to anti-HBc and HBsAg, anti-HBs and sensitive HBV DNA assays. Furthermore, active vaccination or hepatitis B immune globulin may not protect against such mutants.
authors.affiliation: Institute of Virology, University of Cologne, Fürst-Pückler-Street 56, D 50935 Köln, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Awerkiew
authors.forename: Martin
authors.initials: M
authors.lastname: Däumer
authors.forename: Marcel
authors.initials: M
authors.lastname: Reiser
authors.forename: Ulrike C
authors.initials: UC
authors.lastname: Wend
authors.forename: Herbert
authors.initials: H
authors.lastname: Pfister
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaiser
authors.forename: Wulf R
authors.initials: WR
authors.lastname: Willems
authors.forename: Wolfram H
authors.initials: WH
authors.lastname: Gerlich
mesh_terms: D000328:Adult; D005188:False Negative Reactions; D006509:Hepatitis B / Q000097:blood / Q000209:etiology* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000235:genetics / Q000276:immunology; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D016867:Immunocompromised Host; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000276:immunology; D008297:Male; D009154:Mutation; D014766:Viremia; D014775:Virus Activation
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens