Children with Chronic Hepatitis B in the United States and Canada

Abstract

Objectives To test the hypothesis that children with chronic hepatitis B (CHB) living in the US and Canada would also have international origins and characteristic hepatitis B virus (HBV) genotypes and laboratory profiles. Study design Clinical characteristics of children enrolled in the HBRN were collected from 7 US and Canadian centers. Results Children (n=343) with an age range of 1.0 – 17.8 years were enrolled; 78% of the children were Asian, 55% were adopted and 97% had international origins with either the child or a parent born in one of 31 countries. The majority had hepatitis B virus (HBV) genotype B (43%) or C (32%), and the remainder had genotype A (5%), D (16%), E (4%), or multiple (<1%). Children with genotype B or C were Asian (98% and 96%), more consistently hepatitis B e antigen (HBeAg) positive (95% and 82%), had higher median HBV DNA levels (8.2 and 8.3 log10 IU/mL), and less frequently had elevated alanine aminotransferase values (43% and 57%) compared with children with other genotypes. The percentage of HBeAg positivity and of those with HBV DNA ≥6 log10 IU/mL declined with age. Conclusions The majority of children in the HBRN have HBV genotypes which reflect their international origins. Clinical and laboratory data differ substantially by patient age and HBV genotype. Use of these data can help drive the development of optimal strategies to manage and treat children with CHB.

Health‐related Quality of Life in Pediatric Patients With Chronic Hepatitis B Living in the United States and Canada

“…A similar association of lower maternal education and HRQoL was noted in studies of children after liver transplantation (21, 22) and children with kidney disease (22). The majority of our cohort was born outside North America (97%,), children of either adoption or immigrant families (23). For both young children and youth, non-adoptees were more likely to have mothers with lower education level.…”

“…Seven pediatric hepatology centers in the US and Canada participated in the HBRN Pediatric Cohort study (5, 9). Subject inclusion criteria included age 6 months to <18 years and hepatitis B surface antigen (HBsAg)-positive.…”

“…The Hepatitis B Research Network (HBRN) (9) provides a unique opportunity to study a large, well-characterized cohort of children with chronic HBV infection in the US and Canada (5). Using this cohort, we assessed HRQoL in children and youth with chronic HBV using an age-appropriate instrument, the Child Health Questionnaire (CHQ) (10).…”

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

“…Perinatal transmission also occurs in nonendemic countries (including the United States), mostly in children of HBV‐infected mothers who do not receive appropriate HBV immunoprophylaxis at birth. The majority of children and adults with CHB in the United States are immigrants, have immigrant parents, or became exposed through other close household contacts …”

Combination of Entecavir/Peginterferon Alfa‐2a in Children With Hepatitis B e Antigen–Positive Immune Tolerant Chronic Hepatitis B Virus Infection

“…Universal HBV vaccination and prenatal screening in the United States and Canada have decreased the incidence of chronic HBV infection in children born in these countries. New cases of hepatitis B, however, are observed in North America among children of immigrants and children adopted internationally . On average, an estimated 53,800 people with chronic HBV immigrated to the United States annually during 2004‐2008 …”