The study’s goal was to examine clinical phenotypic changes and identify predictors of outcome in infants with chronic hepatitis B virus (HBV) infection born in HBV-endemic countries and monitored in two Italian tertiary care facilities after immigration or adoption. In 2002, a prospective observational research on children with chronic hepatitis B and e-antibodies against hepatitis B began. Patients with liver fibrosis or those requiring antiviral therapy were not eligible. Immunological active individuals had elevated transaminases, whereas immune tolerant patients had normal alanine aminotransferase, indicating that both had significant viral replication. Sixty-nine individuals were followed for a median of 53 months. At the time of admission, 18 children were immunological tolerant, 47 were immune active, and 4 were immune indeterminate. At the last follow-up, 14 of the immunological-tolerant patients were still immune-tolerant, but only 23 of the immune-active children retained their initial immune phenotype. Seroconversion to hepatitis B e antibodies (SCHBe) happened in just two immunological tolerances, whereas SCHBe was obtained in 13 immune active patients. Ethnicity was the sole factor that was independently associated with SCHBe: Asian ancestry lowered the likelihood of SCHBe by 4.1 times when compared to other ethnicities, but viral genotype had no effect.

In foreign-born infants with chronic HBV infection, ethnicity and immunological status phenotype against HBV, rather than HBV genotype, are the major predictors of SCHBe.