De novo infection in a renal transplant recipient caused by novel mutants of hepatitis B virus despite the presence of protective anti-hepatitis B surface antibody.

A renal transplant recipient became persistently positive for hepatitis B virus (HBV) despite preexisting anti-hepatitis B surface (HBs) antibodies. The antigenicity and immunogenicity of wild-type (wt) and mutant HBs antigens (Ags) were compared. In contrast to wt HBsAg, genetic vaccination with mutant HBsAgs did not induce anti-HBs. Thus, mutations within HBsAg may enable HBV to escape immunological control.