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Long-term follow-up of hepatitis B virus carrier infants
1Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Insights
Hepatitis B carrier infants with antibody to hepatitis B core antigen (anti-HBc) may achieve hepatitis B e antigen (HBeAg) seroconversion. Infants without anti-HBc show persistent immune incompetence to hepatitis B virus (HBV) antigens for over 10 years.
Area of Science:
- Hepatology
- Immunology
- Pediatrics
Background:
- Hepatitis B virus (HBV) infection in infants can lead to chronic carriage.
- Antibody to hepatitis B core antigen (anti-HBc) presence may indicate immune response.
- Hepatitis B e antigen (HBeAg) seroconversion is a marker of reduced HBV infectivity.
Purpose of the Study:
- To evaluate the long-term outcomes of infants with hepatitis B surface antigen (HBsAg) carriage.
- To assess the role of anti-HBc in predicting HBeAg seroconversion and clinical course.
- To determine the impact of hepatitis B immunization on carrier infants.
Main Methods:
- Longitudinal follow-up of 122 HBsAg carrier infants for 8-10 years.
- Monitoring of alanine aminotransferase (ALT) levels, HBeAg, hepatitis B virus (HBV) DNA, and anti-HBc.
- Comparison of outcomes between anti-HBc positive and negative infants, and between vaccinated and unvaccinated groups.
Main Results:
- 26.1% of anti-HBc positive carriers experienced ALT elevation; 32.8% achieved HBeAg seroconversion by age 10.
- 2 infants (1.8%) lost HBsAg during follow-up.
- All anti-HBc negative carriers remained HBeAg and HBV DNA positive, with no abnormal ALT or liver disease symptoms.
- Hepatitis B immunization did not significantly alter ALT elevation or HBeAg seroconversion rates.
Conclusions:
- HBeAg seroconversion occurs in about one-third of anti-HBc positive carrier infants within the first decade.
- Anti-HBc negative HBsAg carrier infants may exhibit persistent immune incompetence to HBV antigens for over 10 years.
- Hepatitis B immunization shows no significant impact on the clinical course of HBsAg carrier infants.
Abstract:
One hundred twenty-two hepatitis B surface antigen (HBsAg) carrier infants were followed-up for 8-10 years. One hundred eleven had antibody to hepatitis B core antigen (anti-HBc; 83 had been vaccinated) and the remaining 11 were without anti-HBc (7 had been vaccinated). During the follow-up period, 29 (26.1%) carrier infants with anti-HBc had one or more episodes of alanine aminotransferase (ALT) elevation and up to 32.8% (21/64) of the carriers in this group lost their hepatitis B e antigen (HBeAg) before the age of 10. In addition, 2 (1.8%) carriers lost their HBsAg at the age of 3 and 8, respectively. No significant symptom or sign was noted during HBeAg seroconversion. In contrast, all the carrier infants without anti-HBc were still positive for both HBeAg and hepatitis B virus (HBV) DNA and none displayed abnormal ALT levels or any symptom related to liver disease. One became anti-HBc positive at the age of 9, and 5 other carriers had inconsistent borderline or weakly positive titers of anti-HBc. The episodes of ALT elevation and the prevalence of HBeAg seroconversion were not significantly different between immunized carrier infants. In conclusion, HBeAg seroconversion may occur in about one third of the anti-HBc-positive carrier infants during the first decade. On the other hand, the anti-HBc-negative HBsAg carrier infants' immune incompetence to the HBV antigens could persist for more than 10 years. Hepatitis B immunization did not have significant effect on the clinical course in carriers.