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To study the hepatitis B–specific T cell–mediated immune response in chronically infected children and adolescents.In all, 36 HBsAg-positive patients, 2 to 19 years old, were included. There were 9 HBeAg-positive patients with normal levels of alanine aminotransferase (ALT) (group 1), 18 HBeAg-positive patients with elevated ALT (group 2), and 9 HBeAg-negative, anti-HBe–positive patients (group 3). Four patients in group 2 were treated with interferon during the study. In all patients, HBcAg-specific T cell proliferation and ALT levels were prospectively studied in repeated samples for a mean follow-up time of 1.6 years. The baseline HBV-DNA and plasma cytokine levels were determined, and genotypes were analyzed.The percent of patients with at least 1 sample indicating T cell proliferation was 55% in group 1 and 89% in groups 2 and 3, respectively (P = 0.07 group 1 vs group 2, P = 0.013 group 1 vs the combined groups 2 and 3). Tendencies for positive correlations between the degree of T cell proliferation and ALT levels were noted in groups 1 and 3 and for negative correlations in HBeAg seroconverting patients of group 2. In patients with successful interferon treatment, a pattern of more vigorous T cell proliferation than in patients with spontaneous seroconversion was noted.A majority of patients showed signs of ongoing T cell proliferation. The continuation of the T cell–mediated immune response seems to be of importance in maintaining the HBeAg seroconversion over time.