title: Occult hepatitis B virus infection with positive hepatitis B e antigen.
abstract: BACKGROUND
  Hepatitis B e antigen (HBeAg) is a marker to indicate active replication of hepatitis B virus (HBV). Occult HBV infection (OBI), referred to persistence of HBV DNA in serum and/or liver without detectable serum hepatitis B surface (HBsAg), usually has low HBV DNA levels. The presence of HBeAg in OBI is unusual.
  
  
  METHODS
  We report 2 patients who presented negative for HBsAg but positive for HBeAg and HBV DNA. HBV markers were quantified in the longitudinal sera in a period of 1-2years. The HBV DNA sequences were analyzed in 2 patients' sera and 1 patient's liver.
  
  
  RESULTS
  Both patients were also positive for total anti-HBs and anti-HBc but negative for anti-HBe and anti-HBc IgM. HBV DNA levels were 234-567IU/ml in case 1 and 42-1130IU/ml in case 2. The alignment analysis of the S gene showed that HBV in both patients was genotype C, serotype adr. Cloning analysis of the a determinant of HBsAg showed that the immune escape mutants were predominant in both patients over the follow-up period. The HBV had double mutations (A1762T and G1764A) in the basal core promoter but had no mutation in the pre C/C gene in both patients.
  
  
  CONCLUSIONS
  The patients with negative HBsAg but positive HBeAg may represent a unique type of OBI. Test for HBeAg would be critical to identifying such type of OBI.
authors.affiliation: Department of Laboratory Medicine, East China Sanatorium, Wuxi 214065, Jiangsu Province, China; Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Zhenge
authors.initials: Z
authors.lastname: Han
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Jinshun
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Yongchun
authors.initials: Y
authors.lastname: Bi
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing 210008, China.
authors.forename: Jingli
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China; Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, China; Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing 210008, China. Electronic address: yzh20061111@yahoo.com.
authors.forename: Yi-Hua
authors.initials: YH
authors.lastname: Zhou
mesh_terms: D000369:Aged, 80 and over; D000595:Amino Acid Sequence; D004279:DNA, Viral / Q000097:blood* / Q000276:immunology; D005838:Genotype; D006509:Hepatitis B / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000235:genetics*; D006513:Hepatitis B e Antigens / Q000097:blood / Q000235:genetics*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D057131:Immune Evasion; D008099:Liver / Q000276:immunology / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D011401:Promoter Regions, Genetic; D014758:Viral Core Proteins / Q000235:genetics / Q000276:immunology; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D014758:Viral Core Proteins
keywords: HBeAg; HBsAg mutants; Occult HBV infection