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Changes in hepatitis Be antigen/antibody system in children with chronic hepatitis B virus infection
Insights
In children with chronic hepatitis B, spontaneous HBeAg to anti-HBe seroconversion leads to improved liver health. Persistent HBeAg positivity is linked to ongoing liver disease, while some anti-HBe positive cases progress to cirrhosis.
Area of Science:
- Hepatology
- Virology
- Pediatric Gastroenterology
Background:
- Chronic hepatitis B infection in children requires long-term monitoring.
- The hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti-HBe) system are key serological markers in hepatitis B virus (HBV) infection.
- Understanding the natural history of HBeAg/anti-HBe seroconversion is crucial for predicting disease outcomes in pediatric chronic hepatitis B.
Purpose of the Study:
- To investigate the long-term dynamics of the HBeAg/anti-HBe system in children with chronic hepatitis B or cirrhosis.
- To correlate seroconversion status with clinical, biochemical, and histological outcomes.
- To identify factors associated with favorable or unfavorable disease progression.
Main Methods:
- Longitudinal study of 55 children (52 with chronic hepatitis B, 3 with cirrhosis) over 2-10 years.
- Monitoring of HBeAg and anti-HBe serological markers.
- Assessment of transaminase levels and liver histology.
- Detection of hepatitis B core antigen and delta antigen in liver biopsies.
Main Results:
- Spontaneous HBeAg to anti-HBe seroconversion occurred in 13 of 38 patients (16% annual rate).
- Seroconversion was associated with normalization of transaminases and histological improvement.
- Persistent HBeAg positivity correlated with ongoing liver disease activity.
- Three of nine initially anti-HBe positive patients developed cirrhosis; one had persistent active hepatitis, with delta antigen detected in two.
Conclusions:
- HBeAg/anti-HBe seroconversion in children with chronic hepatitis B generally indicates a favorable prognosis with disease resolution.
- Persistent HBeAg positivity is associated with a higher risk of progressive liver disease.
- The presence of anti-HBe at presentation does not exclude progression to cirrhosis, and co-infections like hepatitis delta virus may influence the disease course.
Abstract:
The long-term changes in the HBeAg/anti-HBe system were examined in 55 children with chronic type B hepatitis (52 patients) or cirrhosis (three patients) during a follow-up period of two to 10 years. At the time of presentation, positive reactions to HBeAg were seen in 46 children, and to anti-HBe in nine. Spontaneous seroconversion from HBeAg to anti-HBe occurred in 13 of 38 patients (average annual rate 16%), mainly those with acute onset of hepatitis B or with features of active liver disease at presentation and with a focal distribution pattern of hepatitis B core antigen in the liver. Normalization of transaminase activity and disappearance of histologic features of activity were the rule in patients in whom seroconversion occurred, but the exception in those who maintained persistently HBeAg-positivity. In contrast to the favorable evolution of illness observed in children showing anti-HBe seroconversion, three of nine patients who had anti-HBe-positive reactions at presentation were found to have liver cirrhosis, and a fourth patient had features of active hepatitis throughout the observation period. Because delta antigen was detected in the liver in two of these patients, it is conceivable that etiologic cofactors could have influenced their course of chronic hepatitis.