Baseline Level of Hepatitis B Core Antibody Predicts Spontaneous Hepatitis B e Antigen (HBeAg) Seroconversion in HBeAg‐Positive Children With a Normal Alanine Aminotransferase Level

• Published in: Hepatology (Baltimore, Md.) Vol. 70; no. 6; pp. 1903 - 1912
• Main Authors: Chen, Ho‐Sheng, Wu, Jia‐Feng, Su, Tung‐Hung, Chen, Huey‐Ling, Hsu, Hong‐Yuan, Xia, Ning‐Shao, Chen, Pei‐Jer, Chang, Mei‐Hwei
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc 01.12.2019
• Subjects: Alanine; Alanine transaminase; Antigens; Children; Chronic infection; Genotypes; Health risk assessment; Hepatitis; Hepatitis B; Hepatitis B e antigen; Hepatitis B surface antigen; Hepatology; Immune response; Seroconversion; Survival analysis
• ISSN: 0270-9139; 1527-3350; 1527-3350
• DOI: 10.1002/hep.30788

It is not clear whether 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 anti‐HBc level and the natural course of chronic hepatitis B (CHB) virus (HBV) infection in children, particularly the ability of 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. Anti‐HBc level was determined by double‐sandwich immunoassay. 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 years (interquartile range [IQR], 10.3‐15.3) were followed for a median of 19.8 years (IQR, 11.9‐21.9). Spontaneous HBeAg seroconversion occurred in 85 children (46.7%) during the follow‐up. A baseline anti‐HBc titer of >500 IU/mL (hazard ratio [HR] = 2.81), HBV genotype B and B + C (HR = 3.46), and a baseline hepatitis B surface antigen titer of ≤4.8 log10 IU/mL (HR = 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 because of ongoing inflammation. Conclusion: Baseline anti‐HBc level is predictive of spontaneous HBeAg seroconversion in HBeAg‐positive children with a normal ALT level. Anti‐HBc level reflects anti‐HBV immune response in the HBeAg‐positive normal ALT phase of CHB.