The baseline hepatitis B core antibody (anti-HBc) level is predictive of spontaneous hepatitis B e antigen (HBeAg) seroconversion in HBeAg-positive children with a normal alanine aminotransferase (ALT) level, according to a longitudinal study published in Hepatology.1

Anti-HBc is a sensitive marker of hepatitis B virus (HBV) infection, and baseline anti-HBc levels are predictive of HBeAg seroconversion in adults with chronic hepatitis B (CHB) treated with peg-interferon or nucleotide analogues.2-4 While anti-HBc is a biomarker of hepatic inflammation in adults with CHB and a normal ALT level,5 few studies have focused on anti-HBc levels in children and whether baseline anti-HBc levels in HBeAg-positive children with CHB and a normal ALT level is predictive of HBeAg seroconversion. Therefore, researchers investigated the correlation between anti-HBc level and the natural course of CHB infection in children, particularly the ability of the baseline anti-HBc level to predict spontaneous HBeAg seroconversion during long-term follow-up.1 They followed 182 children for a median of 19.8 years and found that spontaneous HBeAg seroconversion occurred in 85 children (46.7%). A baseline anti-HBc titer of >500 IU/mL, HBV genotype B and B+C, and a baseline hepatitis B surface antigen titer of ≤4.8 log10 IU/mL were predictive of spontaneous HBeAg seroconversion. In children that remained HBeAg positive, anti-HBc levels gradually increased because of ongoing inflammation.

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The authors concluded that, “The baseline anti-HBc level is predictive of spontaneous HBeAg seroconversion in HBeAg-positive children with a normal ALT level.”1 They added that, “The anti-HBc level reflects anti-HBV immune response in the HBeAg-positive normal ALT phase of CHB.”


References
1. Chen HS, Wu JF, Su TH, et al. Baseline level of hepatitis B core antibody predicts spontaneous HBeAg seroconversion in HBeAg-positive children with a normal ALT level [published online May 23, 2019]. Hepatology. doi:10.1002/hep.30788.

2. Wu T, Kwok RM, Tran TT. Isolated anti-HBc: the relevance of hepatitis B core antibody – A review of new Issues. Am J Gastroenterol. 2017;112:1780-1788.

3. Fan R, Sun J, Yuan Q, et al. Baseline quantitative hepatitis B core antibody titre alone strongly predicts HBeAg seroconversion across chronic hepatitis B patients treated with peginterferon or nucleos(t)ide analogues. Gut. 2016;65:313-320.

4. Yuan Q, Song LW, Liu CJ, et al. Quantitative hepatitis B core antibody level may help predict treatment response in chronic hepatitis B patients. Gut. 2013;62:182-184.

5. Zhou J, Song L, Zhao H, et al. Serum hepatitis B core antibody as a biomarker of hepatic inflammation in chronic hepatitis B patients with normal alanine aminotransferase. Sci Rep. 2017;7:2747.