Identification of a novel tri-genotypic recombinant Hepatitis B virus in Bangladesh.

We report a novel tri-genotypic recombinant Hepatitis B virus (HBV) strain circulating in Bangladesh. The strain is recombinant with the genotypes D, C and E, of which, genotype E was not reported before in Bangladesh. Additionally, the complete genome has a frameshift deletion of nine nucleotides from overlapping Surface and Polymerase genes, and a vaccine escape mutation, A128 V, in the surface protein. This is the first report with such unusual recombination event responsible for rapid liver cirrhosis in a 13 year old patient in Bangladesh. This report may alert the clinicians to take the measure to prevent an upcoming outbreak of recombinant HBV.