Boys with Chronic Hepatitis B May Experience HBeAg Seroconversion and Reduced HBV Viral Load at Puberty

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http://www.hivandhepatitis.com/2010_conference/croi/docs/0309_2010_b.htmlHIV and

Hepatitis.com Coverage of the 17th Conference on Retroviruses andOpportunistic

Infections (CROI 2010)  February 16 - 19, San Franciso, California  Boys with

Chronic Hepatitis B May Experience HBeAg Seroconversion and Reduced HBV Viral

Load at Puberty     SUMMARY: Boys with chronic hepatitis B virus (HBV)

infection may experience hepatitis B " e " antigen (HBeAg) seroconversion and see

a reduction in HBV DNA levels when they reach puberty, according to a study

published in the March 2010 issue of Gastroenterology. These findings shed

further light on sex differences in the natural history of hepatitis B.      By

Liz HighleymanGiven that male predominance is a " remarkable phenomenon " in

HBV-related liver disease, J.F. Wu and colleagues from the National Taiwan

University Hospital in Taipei sought to determine the effects of puberty on

spontaneous (without treatment) HBeAg seroconversion in boys.It has long been

recognized that women with chronic viral hepatitis tend to experience slower and

milder liver disease progression than men. This might be due to protective

effects of the female sex hormone estrogen or detrimental effects of the male

hormone testosterone.The study included 100 initially HBeAg positive male

children with chronic HBV infection who were recruited when they were less than

10 years old and followed for more than 10 years; participants were selected at

random from a long-term follow-up cohort. The researchers measured serum

testosterone levels, as well as genetic polymorphisms (variations) in androgen

receptor exon-1 CAG repeat number and steroid 5 alpha reductase type II (SRD5A2,

valine vs leucine alleles). They compared outcomes among 87 boys with earlier

onset of puberty (defined as serum testosterone>2.5 ng/mL at age 15) versus 13

with later puberty.Results 72 participants (72%) experienced spontaneous HBeAg

seroconversion during follow-up.  Boys with earlier-onset puberty experienced

significantly earlier HBeAg seroconversion on average than those with later

puberty (at a median age of 13.2 vs 22.5 years; hazard ratio 2.95). The early

puberty onset group also had significantly higher peak alanine aminotransferase

(ALT) levels while they were HBeAg positive (306 vs 155 IU/L). Finally, the

early puberty group experienced significantly greater HBV viral load reduction

between 10 and 20 years of age than the late puberty group (1.6 vs 0.2 log10

copies/mL). Having the valine allele at the SRD5A2 V89L polymorphism site was

also associated with earlier spontaneous HBeAg seroconversion (at a median age

of 11.7 vs 18.7 years; hazard ratio 1.88).Based on these findings, the study

authors concluded, " Earlier-onset puberty and increased SRD5A2 enzyme activity

are associated with earlier HBeAg seroconversion, higher serum alanine

aminotransferase levels, and a greater HBV viral load decrement in chronic HBV

infected males. " Since earlier puberty -- with its increase in testosterone --

led to HBeAg conversion and lower HBV DNA, both of which are associated with

milder liver disease, these findings do not explain faster disease progression

in men.Department of Pediatrics, National Taiwan University Hospital, Taipei,

Taiwan.3/12/10ReferenceJF Wu, WY Tsai, HY Hsu, and others. Effect of Puberty

Onset on Spontaneous Hepatitis B Virus e Antigen Seroconversion in Men.

Gastroenterology 138(3): 942-948.e1 (Abstract). March 2010.