Virologic features of chronic hepatitis B virus infection in childhood.

Hepatitis B virus markers were studied in serum and liver of 24 children with chronic hepatitis. All patients had evidence of active virus replication, as shown by hepatitis B core antigen in the liver cell nuclei, independently of the severity of histologic lesions. Furthermore, 19 of 24 patients had hepatitis B e antigen in serum, and most patients showed a diffuse pattern of HBcAg distribution in the liver. In all 24 children, the presence of immunoglobin G bound to the liver cell surface paralleled the activity of virus replication, but it did not correlate with the severity of liver lesions. During a follow-up period of two to four years, the virus replication persisted in all eight patients receiving immunosuppressive therapy, whereas in 5 of 16 untreated patients we observed a seroconversion to antibody to HBeAg, which is currently regarded as a favorable event for the prognosis of the disease.