Long-term follow-up of chronic hepatitis B virus infection in children of different ethnic origins.
The natural history of chronic hepatitis B in children is influenced by mode of transmission and varies with regional endemicity. Seroconversion rates were studied in 174 hepatitis B e antigen (HBeAg)-positive children who were of different ethnic origins and living in Canada. Overall, 40.2% became anti-HBeAg positive, and 8.6% were hepatitis B surface-antigen positive during a mean follow-up of 4.5 years. Spontaneous seroconversion rates were lower in Asian-born, mainly vertically infected, children, versus those born either in Canada or where horizontal transmission predominates (24% vs. 44%, P=.015). Kaplan-Meier analysis showed that the cumulative persistence of HBeAg after 13 years was 25% in Asian-born children, versus 6% in all others (P<.05). Treatment of 27 children accelerated seroconversion by 3 years, without influencing the proportion seroconverting over time. Thus, although Asian-born children seroconvert more slowly, a large proportion will seroconvert before adulthood. Because treatment appears to accelerate anti-HBe seroconversion, longitudinal studies are required in order to assess the long-term benefits of early treatment.
Marx
George
G
Division of Gastroenterology, Hepatology and Nutrition, Sainte-Justine Hospital, Montreal, Canada. george.marx@gd.kispi.sg.ch
Martin
Steven R
SR
Chicoine
Jean-Francois
JF
Alvarez
Fernando
F
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D001208:Asia / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005006:Ethnicity; D005061:Europe, Eastern / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D007223:Infant; D007843:Latin America / Q000208:ethnology; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D011792:Quebec / Q000453:epidemiology / Q000208:ethnology; D016036:Seroepidemiologic Studies; D000509:alpha-Fetoproteins / Q000032:analysis
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins; D000410:Alanine Transaminase