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Baseline Level of Hepatitis B Core Antibody Predicts Spontaneous HBeAg Seroconversion in HBeAg-Positive Children with a Normal ALT Level
May 2019Hepatology
Ho-Sheng Chen Jia-Feng Wu Jia-Feng Wu Tung-Hung Su Tung-Hung Su
Mei-Hwei Chang
Abstract
It is not clear whether the baseline hepatitis B core antibody (anti-HBc) level in hepatitis B e
antigen (HBeAg)-positive children with a normal alanine aminotransferase (ALT) level is predictive of spontaneous HBeAg seroconversion. We investigated the correlation between the anti-HBc level and the natural course of chronic hepatitis B (CHB) virus (HBV) infection in children, particularly the ability of the baseline anti-HBc level to predict spontaneous HBeAg seroconversion during long-term follow-up. HBeAg-positive children with untreated CHB and a
normal ALT level were followed longitudinally. The anti-HBc level was determined by double-
sandwich immunoassay. The effects of anti-HBc levels and other parameters on spontaneous
HBeAg seroconversion and the natural course of CHB were assessed. A total of 182 children
(106 males) with a median age at enrollment of 10.6 (interquartile range 10.3–15.3) years was followed for a median of 19.8 (interquartile range 11.9–21.9) years. Spontaneous HBeAg seroconversion occurred in 85 children (46.7%) during the follow-up. A baseline anti-HBc titer
of > 500 IU/mL (hazard ratio= 2.81), HBV genotype B and B+C (hazard ratio= 3.46), and a
baseline hepatitis B surface antigen titer of ≤ 4.8 log10 IU/mL (hazard ratio= 3.09) were
predictive of spontaneous HBeAg seroconversion, based on multivariable survival analysis
(P < 0.001). In cases remaining HBeAg positive, their anti-HBc levels increased gradually during follow-up due to ongoing inflammation.
Conclusion: The baseline anti-HBc level is predictive of spontaneous HBeAg seroconversion in HBeAg-positive children with a normal ALT level. The anti-HBc level reflects anti-HBV
immune response in the HBeAg-positive normal ALT phase of CHB. |
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