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Journal of Clinical Microbiology, June 2004, p. 2861-2865, Vol. 42, No. 6
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.6.2861-2865.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Hepatitis B Surface Antigen Variant with Multiple Mutations in the a Determinant in an Agammaglobulinemic Patient

Alexandra Alexopoulou,1 Gerasimos Baltayiannis,2 Saffie Jammeh,2 Jenny Waters,2 Spyros P. Dourakis,1 and Peter Karayiannis2*

Academic Department of Medicine, Hippokration General Hospital, Athens, Greece,1 Department of Medicine, Imperial College London, Faculty of Medicine, St. Mary's Campus, London, United Kingdom2

Received 4 December 2003/ Returned for modification 26 January 2004/ Accepted 17 February 2004

A patient with agammaglobulinemia developed acute hepatitis that progressed to chronic liver disease with high levels of hepatitis B virus (HBV) DNA in the absence of detectable HBsAg. Sequencing of the a determinant region of HBsAg revealed multiple amino acid substitutions that, unusually, also included a substitution at position 122 that defines subtype specificity. All of these mutations had a profound effect on the antigenicity of this region, which led to the complete failure of variant detection by commercially available routine diagnostic assays or laboratory-based monoclonal antibody assays.

* Corresponding author. Mailing address: Department of Medicine A, Faculty of Medicine, Imperial College London, St. Mary's Campus, South Wharf Rd., London W2 1NY, United Kingdom. Phone: 44 207 886 6381. Fax: 44 207 724 9369. E-mail: p.karayiannis{at}imperial.ac.uk.

Journal of Clinical Microbiology, June 2004, p. 2861-2865, Vol. 42, No. 6
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.6.2861-2865.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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Copyright © 2004 by the American Society for Microbiology. All rights reserved.