Chen HS, Wu JF, Su TH, et al. - In HBeAg-positive children with a normal alanine aminotransferase (ALT) level, baseline hepatitis B core antibody (anti-HBc) level was assessed as a predictor of spontaneous HBeAg seroconversion. Researchers longitudinally followed HBeAg-positive children with untreated chronic hepatitis B (CHB) and a normal ALT level. Using double-sandwich immunoassay, they measured anti-HBc level. For a median of 19.8 years, they observed overall 182 children (106 males) with a median age of 10.6 years at study entry. Follow-up revealed the occurrence of spontaneous HBeAg seroconversion in 85 children (46.7%). According to multivariable survival analysis, spontaneous HBeAg seroconversion was predicted by a baseline anti-HBc titer of > 500 IU/mL, hepatitis B virus (HBV) genotype B and B + C, and a baseline hepatitis B surface antigen titer of ≤ 4.8 log10 IU/mL. In this patient population, baseline anti-HBc level was found to be predictive of spontaneous HBeAg seroconversion. In the HBeAg-positive normal ALT phase of CHB, anti-HBV immune response was reflected by anti-HBc level.