Outcome of chronic hepatitis B in Caucasian children during a 20-year observation period

Bortolotti, Flavia; Jara, Paloma; Crivellaro, Carlo; Hierro, Loreto; Cadrobbi, P; Frauca, E; Camarena, C.; Vega, A. de la; Díaz, Carmen; Moliner, Lorena De; Noventa, Franco

doi:10.1016/s0168-8278(98)80002-0

Cited by 120 publications

(85 citation statements)

References 17 publications

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“…After HBeAg seroconversion a small number of patients remained with active liver disease, findings that have been observed in other studies [Fattovich et al, 1986;Evans et al, 1997;Bortolotti et al, 1998;Hsu et al, 2002]. The persistence of hepatitis after HBeAg seroconversion is probably due to emergence and activation of HBV variants, most likely the precore mutant variants [Hadziyannis and Vassilopoulos, 2001b].…”

Section: Discussionsupporting

confidence: 58%

Natural history of chronic HBV infection: A cohort study with up to 12 years follow-up in North Greece (part of the Interreg I-II/EC-project)

et al. 2005

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The aim of the study was to assess the long-term outcome of chronic hepatitis B surface antigen (HBsAg) carriers in the general population in North Greece (Thrace), an area with an intermediate endemicity. This was a part of the Interreg I-II EC project. Two hundred sixty three chronic HBsAg+ carriers, median age 34 years (20-65), were evaluated prospectively for a median follow-up of 5 years (2-12). Hepatitis B virus (HBV) markers and ALT were examined every 6 months and serum HBV-DNA every 12 months. Liver biopsy was undertaken at presentation and every 2-4 years. Fourteen of 263 (5.3%) subjects were HBeAg+ and 249/263 (94.7%) HBeAg(-)/anti-HBe+ of whom 48 (19.3%) had elevated ALT, and HBV-DNA levels ranging from 1.4 x 10(5)-4 x 10(7) copies/ml. Inactive carriers (98/195 (50.3%)) had detectable HBV-DNA (median 2.6 x 10(3) range 0.042 x 10(4)-1.9 x 10(4) copies/ml); 4/195 (2%) exhibited HBV reactivation during the observation period (all had HBV-DNA >10(4) copies/ml at presentation). Patients (7/14 (50%) HBeAg+) developed anti-HBe+, annual rate 10%. Subjects (16/195 (8%)) lost HBsAg, all were inactive carriers; 10 developed anti-HBs (annual rate 1%). Liver biopsy was normal or with minimal changes in 92/95 (97%) inactive carriers and remained so at 4 years follow-up. In contrast, 4/48 (8.3%) HBeAg(-)/anti-HBe+ patients with active disease had deterioration of liver histology. In this cohort study: (a) the annual seroconversion rate was 1% for the HBsAg and 10% for the HBeAg, (b) 23.6% of the HBsAg+ carriers had active liver disease and 39% moderate fibrosis at presentation of whom a small proportion deteriorated over the observation period, (c) HBsAg carriers with HBV-DNA level <10(4) copies/ml had persistently normal ALT and unchanged liver histology over the follow-up period of up to 12 years.

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Section: Discussionsupporting

confidence: 58%

Natural history of chronic HBV infection: A cohort study with up to 12 years follow-up in North Greece (part of the Interreg I-II/EC-project)

et al. 2005

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“…Several studies on CHB acquired during childhood revealed a benign course of disease [7,21,22]. In a study including 52 children followed up for 3-22 years, Fujisawa et al [21] reported a percentage of HBeAg clearance of 83.3% in untreated patients and 87.5% in treated patients; none of the patients achieved an undetectable HBsAg level.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome in Children with Chronic Hepatitis B: A 24-Year Observation Period

Iorio

Giannattasio

Cirillo

et al. 2007

Clinical Infectious Diseases

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Background. Chronic hepatitis B seems to manifest as mild disease in children and young adults. However, data regarding the long-term course of hepatitis B in untreated and interferon-treated children are still scarce. This study investigates the long-term outcome of disease in a large series of untreated and treated children with hepatitis B virus (HBV) infection.Methods. Clinical, biochemical, virological, and histological features were evaluated in children (age range, 2-18 years) with chronic HBV infection who did not have concomitant chronic systemic diseases other than HBV infection and who were admitted to the liver unit in the Department of Pediatrics at University "Frederico II" (Naples, Italy) during the period 1981-2005.Results. One hundred eight consecutive patients observed for up to 24 years were studied. During the observation period, 67 children remained untreated, and 41 were treated with interferon-a. After a median period of observation of 12.1 years (range, 5-23 years), hepatitis B early antigen loss and serum HBV DNA clearance occurred in 43 untreated patients (69.3%) who were hepatitis B early antigen positive at study entry and in 33 treated children (80%; the P value is not statistically significant). In addition, 6 untreated patients (9.7%) and 4 treated patients (9.7%) became hepatitis B surface antigen positive at the end of the follow-up period. Histological assessment, evaluated for 57 children, showed mild-to-moderate disease in 91.2% of cases of HBV infection. No patient developed end-stage liver disease or hepatocellular carcinoma.Conclusions. Children with chronic HBV infection are symptom free, with morphologically mild liver disease. Considering that the overall long-term outcomes did not differ between treated and untreated patients, the real impact of therapy on the long-term course of HBV infection remains to be established. Additional studies are needed to confirm our conclusions.

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“…According to a study of the population-based prevalence of infections by the hepatitis B and C viruses (HBV and HCV), conducted between 2005 and 2009 in all Brazilian capitals and the Federal District, the frequency of viral hepatitis B and C in people between the ages of 10 and 69 was 7.4% and 1.38% respectively, which is consistent with low endemicity of these conditions [9] . Few studies have attempted long-term outcome of children with hepatitis B [10,11] . At least 50% of children infected by the vertical route (mother-to-child) test positive for viral replication in adulthood.…”

Section: Viral Hepatitismentioning

confidence: 99%

Cirrhosis in children and adolescents: An overview

Pinto

Schneider

Silveira

2015

WJH

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Several conditions, especially chronic liver diseases, can lead to cirrhosis in children and adolescents. Most cases in clinical practice are caused by similar etiologies. In infants, cirrhosis is most often caused by biliary atresia and genetic-metabolic diseases, while in older children, it tends to result from autoimmune hepatitis, Wilson's disease, alpha-1-antitrypsin deficiency and primary sclerosing cholangitis. The symptoms of cirrhosis in children and adolescents are similar to those of adults. However, in pediatric patients, the first sign of cirrhosis is often poor weight gain. The complications of pediatric cirrhosis are similar to those observed in adult patients, and include gastrointestinal bleeding caused by gastroesophageal varices, ascites and spontaneous bacterial peritonitis. In pediatric patients, special attention should be paid to the nutritional alterations caused by cirrhosis, since children and adolescents have higher nutritional requirements for growth and development. Children and adolescents with chronic cholestasis are at risk for several nutritional deficiencies. Malnutrition can have severe consequences for both pre-and post-liver transplant patients. The treatment of cirrhosis-induced portal hypertension in children and adolescents is mostly based on methods developed for adults. The present article will review the diagnostic and differential diagnostic aspects of end-stage liver disease in children, as well as the major treatment options for this condition.

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Outcome of chronic hepatitis B in Caucasian children during a 20-year observation period

Cited by 120 publications

References 17 publications

Natural history of chronic HBV infection: A cohort study with up to 12 years follow-up in North Greece (part of the Interreg I-II/EC-project)

Natural history of chronic HBV infection: A cohort study with up to 12 years follow-up in North Greece (part of the Interreg I-II/EC-project)

Long-Term Outcome in Children with Chronic Hepatitis B: A 24-Year Observation Period

Cirrhosis in children and adolescents: An overview

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