Email this article 
Hide
Show all
Case Report
Atypical hepatitis B surface antigen escape mutations in an HIV-positive patient in South Africa
Submitted: 06 February 2026 | Published: 30 June 2026
About the author(s)
Menzi B. Nkosi, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South AfricaMarije van Schalkwyk, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Tongai G. Maponga, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Yoliswa Z. Chili, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Devon Muir, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Paula R. Delport, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Susan S. Hugo, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Zahiera Ismail, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Jantjie Taljaard, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Gert U. van Zyl, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
Wolfgang Preiser, Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town Tygerberg Business Unit, National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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.
Contribution: Findings are most consistent with hepatitis B virus reactivation following prior natural infection and subsequent loss of immune control.
Keywords
Metrics
Total abstract views: 274Total article views: 246