Chronic Hepatitis B in Children, Report of a Single-Centre Longitudinal Study on 152 Children
Olivia C Arnone 1 , Daniele Serranti 1 , Elisa Bartolini 1 , Greta Mastrangelo 2 , Mariangela Stinco 1 , Sandra Trapani 3 , Silvia Ricci 3 , Massimo Resti 1 , Giuseppe Indolfi 1 2
Affiliations
Affiliations
1
Liver Unit, Meyer Children's University Hospital.
2
Department NEUROFARBA, University of Florence.
3
Department of Health Sciences, University of Florence.
PMID: 32853482 DOI: 10.1111/jvh.13382
Abstract
The aims of this prospective study were: 1) to describe the natural history of chronic hepatitis B virus (HBV) infection in a large cohort of untreated children followed at a single centre, and 2) to evaluate whether or not the new European Association for the Study of Liver (EASL) classification for the phases of HBV infection in adults can be used for children. All children who presented at the Liver Unit of our hospital from January 1st 1987, to December 31st 2019, and were diagnosed with chronic HBV infection were enrolled. The final sample consisted of 152 children. The median duration of the follow-up was 83 months (range 7-232). At baseline, 125 patients (82.2%) were HBeAg positive (85.3% abnormal alanine aminotransferase (ALT) levels), 24 (15.8%) were HBeAg-negative (93.3% abnormal ALT). At the end of the observation period, 62 of the HBeAg-positive patients (40.7%) achieved HBeAg seroconversion (median age 9.45 years, range 0.8-19) and 2 (1.4%) achieved HBsAg seroconversion. Elevated ALT serum levels at baseline (p=0.011), lower baseline HBV DNA levels (p<0.001) and Asian ethnicity (p=0.0001) were identified as predisposing factors towards HBeAg seroconversion. EASL criteria could not be applied to 43.3% and 43.5% of the children at baseline and at end of observation, respectively that were grouped into an undetermined phenotype category. According to the results of the present study, the new EASL guidelines for adults with HBV infection cannot be applied in a satisfactory manner in children.