Clinical Course of Chronic Hepatitis B in Children

		SUMMARY: Although children with chronic hepatitis B typically experience relatively mild disease, some develop advanced liver damage, according to a Polish study reported in the December 2009 European Journal of Gastroenterology & Hepatology. Out of 200 children studied, 4% had advanced fibrosis or cirrhosis, and progression appeared to be related to age at the time of infection.

By Liz Highleyman

Iwona Mozer-Lisewska from the University of Medical Sciences in Poznañ, Poland, and colleagues conducted a study to assess inflammatory activity, liver fibrosis, and their relation to clinical data in children with chronic hepatitis B who were not yet receiving antiviral treatment.

The study included 200 children with chronic hepatitis B, aged 1.5 to 18 years (mean 7.5 years), who were hospitalized before liver biopsy between 1992 and 2003.

The investigators analyzed disease history and clinical data. Necroinflammatory activity refers to degree of liver cell death and inflammation, indicated by biopsy findings and elevations in ALT and AST liver enzymes. Histopathological assessment, or degree of fibrosis seen in a biopsy specimen, was based on the modified Knodell staging system.

Results

	115 children (58%) were found have mild necroinflammatory activity and 44 (22%) had was moderate activity.
	93 children (47%) had minimal fibrosis (stage 1), 62 children (31%) had moderate fibrosis (stage 2), and the remaining 8 children (4%) had severe fibrosis or cirrhosis (stage 3-4).
	ALT activity was proportional to staging, and was significantly higher in children with fibrosis stage 2 or higher.
	Spontaneous hepatitis B early or "e" antigen (HBeAg) seroconversion occurred in 30 of 200 children (15%), and was related to shorter length of infection.

Based on these findings the study authors concluded, "Intensity of liver injury in children with chronic hepatitis B varies from minimal to marked necroinflammatory activity and fibrosis varies from none to advanced."

"Progression of liver fibrosis seems to be proportional to the age at infection," they continued. "ALT activity appears to be higher in the children with significant (S2-S4) fibrosis. Spontaneous hepatitis B early antigen seroconversion is apparently related to the shorter length of infection and higher ALT activity."

Department of Infectious Diseases and Child Neurology, University of Medical Sciences, Poznañ, Poland.

1/22/10

Reference
I Mozer-Lisewska, A Mania, W Sluzewski , and others. Factors influencing clinical course and histological findings in children with chronic hepatitis B. European Journal of Gastroenterology & Hepatology 21(12): 1400-1406 (Abstract). December 2009.