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.