Spontaneous loss of HBsAg in children with chronic hepatitis B virus infection.
Spontaneous loss of HBsAg is infrequent in adult HBV carriers. Little is known about this serological change in children. In a prospective study of 420 hepatitis B virus-carrier children who were observed for 1 to 12 yr (mean = 4.3 yr), spontaneous loss of HBsAg occurred in 10 patients, with an average incidence of 0.6%/yr. The HBsAg clearance rate was significantly higher in children who had anti-HBe; children who were at an older age on entry; children whose mothers were HBsAg-; or children with severe liver histological changes detected while they were HBeAg+. Children who seroconverted from HBeAg to anti-HBe before the age of 6 or who had a peak serum ALT level above 100 IU/L were more likely to clear HBsAg. In all 10 patients who became HBsAg-, serum hepatitis B virus DNA became undetectable by both spot hybridization and the polymerase chain reaction, suggesting a complete clearance of the virus from serum. After the loss of HBsAg, the anti-HBs levels were higher in the children born to carrier mothers than in those born to noncarrier mothers. These findings suggest that chronic hepatitis B virus-carrier children rarely lose HBsAg, especially if they have been infected during the perinatal period and have mild histological changes. The poor humoral immune response to HBsAg may be a contributing factor in the establishment of carrier status during horizontal infection but may not be primarily involved in the establishment of carrier status during perinatal infection.
Hsu
H Y
HY
Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Republic of China.
Chang
M H
MH
Lee
C Y
CY
Chen
J S
JS
Hsu
H C
HC
Chen
D S
DS
D000293:Adolescent; D001483:Base Sequence; D002353:Carrier State / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006509:Hepatitis B / Q000276:immunology* / Q000473:pathology; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D008297:Male; D008969:Molecular Sequence Data; D009035:Mothers; D015345:Oligonucleotide Probes / Q000235:genetics; D011446:Prospective Studies
D006514:Hepatitis B Surface Antigens; D015345:Oligonucleotide Probes