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Absence or delayed appearance of hepatitis B core antibody in chronic hepatitis B surface antigen carrier children
1Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Republic of China.
Insights
In children carrying the hepatitis B surface antigen (HBsAg), the hepatitis B core antibody (anti-HBc) sometimes fails to appear or is delayed, particularly in those infected perinatally. This study followed 420 HBsAg carrier children to investigate anti-HBc development.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B virus (HBV) infection can lead to chronic carriage.
- The role and timing of hepatitis B core antibody (anti-HBc) development in HBsAg carrier children are not fully understood.
Purpose of the Study:
- To investigate the longitudinal development of anti-HBc in children who are hepatitis B surface antigen (HBsAg) carriers.
- To identify factors associated with the absence or delayed appearance of anti-HBc.
Main Methods:
- Longitudinal follow-up of 420 HBsAg carrier children.
- Serological testing for HBsAg, HBeAg, and anti-HBc.
- Hepatitis B virus DNA (HBV-DNA) quantification.
- Liver biopsy in select cases.
Main Results:
- 10 (2.4%) children showed absence or delayed anti-HBc appearance.
- Absence of anti-HBc occurred in 4 children, including one with hepatitis B vaccine failure and three born to HBsAg carrier mothers.
- Delayed anti-HBc appearance (2-8 years) was observed in 6 children, all born to HBsAg carrier mothers.
- High HBV replication (HBsAg and HBV-DNA) was noted in all 10 children.
- Absence of anti-HBc was strongly associated with perinatal infection.
Conclusions:
- The absence or delayed appearance of anti-HBc is uncommon in HBsAg carrier children but is linked to high HBV replication and perinatal infection.
- Further investigation is needed to understand the long-term implications of absent or delayed anti-HBc in this population.
Abstract:
An absence of the hepatitis B core antibody (anti-HBc) in hepatitis B surface antigen (HBsAg) carrier children has been reported before, but whether anti-HBc will ultimately appear is unknown. In a group of 420 HBsAg carrier children who were followed longitudinally, 10 (2.4%) had an absence or delayed appearance of serum anti-HBc. These 10 children were persistently seropositive for HBsAg, hepatitis B e-antigen, and hepatitis B virus DNA (HBV-DNA). Anti-HBc never appeared in 4, one of whom was a case of hepatitis B vaccine failure and became an HBsAg carrier. Three of the 4 were born to HBsAg carrier mothers. Liver biopsy in one revealed non-specific reactive hepatitis (NSRH). All 4 were asymptomatic during follow-up. Mothers of the other 6 children who had delayed appearance of anti-HBc were also HBsAg carriers. The children seroconverted to anti-HBc positivity between 2 and 8 years of age, and the titer of serum anti-HBc at the first appearance varied. There were no significant changes in liver function tests, HBV-DNA levels, or associated symptoms and signs before and after seroconversion. Liver biopsies were performed before anti-HBc seroconversion in 2 children and showed NSRH. All 10 children had a moderate to high replication of HBV as shown by the high titer of HBsAg and HBV-DNA. The absence of anti-HBc occurred almost exclusively in children who were infected perinatally.(ABSTRACT TRUNCATED AT 250 WORDS)