THE SIGNIFICANCE OF SPONTANEOUS HEPATITIS-B E-ANTIGEN SEROCONVERSION IN CHILDHOOD - WITH SPECIAL EMPHASIS ON THE CLEARANCE OF HEPATITIS-B E-ANTIGEN BEFORE 3 YEARS OF AGE

To investigate the significance of spontaneous hepatitis B e antigen ( HBeAg) seroconversion during childhood, 415 hepatitis E surface antige n (HBsAg) carrier children (ages 0 to 15 years) were prospectively fol lowed for 7.1 +/- 2.9 years. Hepatitis B virus (HBV) markers and Liver function profiles of each child were tested at least once every 6 mon ths. Among them, 50 were initially anti-HBe positive and 140 seroconve rted from HBeAg to anti-HBe during follow-up. Before HBeAg seroconvers ion, jaundice occurred in 9 and alanine transaminase (ALT) activities elevated in 99 of the 140 seroconverters. Serum ALT returned to normal in all patients within 1 to 5 years of seroconversion. Six had reelev ated ALT later after seroconversion. Only 7 (9.7%) of the 72 carrier i nfants seroconverted before 3 years of age. The peak. ALT levels in fi ve of them exceeded 100 IU/L, and two had jaundice before HBeAg seroco nversion. One of the early seroconverters developed hepatocellular car cinoma (HCC) at 11 years of age, although his liver function profiles remained normal after HBeAg seroconversion. Liver biopsy specimens fro m 30 children during the anti-HBe-positive stage showed inactive cirrh osis in 2 (including one with HCC), chronic hepatitis with marked fibr osis in 1, mild activity and moderate fibrosis in 2, mild activity and mild fibrosis in 9, and minimal histologic changes in the remaining 1 6. Although most will achieve a normalization of ALT and inactive live r histologic changes, the seroconversion of HBsAg carrier children fro m HBeAg to anti-HBe is not necessarily an indicator of favorable progn osis; a small proportion of children will develop cirrhosis or even HC C.