Chronic hepatitis B in children after e antigen seroclearance: final report of a 29-year longitudinal study.
Chronic hepatitis B is usually a benign disease in Caucasian children; however, the long-term prognosis remains unsettled. This report describes the results of a 29-year longitudinal study including 99 white children with chronic hepatitis B, mainly acquired horizontally: 91 were hepatitis B e antigen (HBeAg) positive (4 had cirrhosis), and 8 were HBeAg negative at presentation. Of the 91 HBeAg-positive children, 89 underwent HBeAg seroconversion after a mean period of 5.2 +/- 4.0 years and were included in the study. Of the 85 children without cirrhosis, one had HBeAg-negative hepatitis and the other 84 became inactive carriers. During a mean follow-up of 14.5 +/- 6.1 years after HBeAg seroclearance, 4 carriers experienced reactivation, and 3 of them had HBeAg-negative hepatitis at the last follow-up. Of the 8 initially HBeAg-negative children, 2 had HBeAg-negative hepatitis, and 6 were inactive carriers. Of the 4 children with cirrhosis, 2 had hepatocellular carcinoma (HCC) and remained alive and 2 lost the histological features of cirrhosis in adulthood. Two patients with HBeAg-negative hepatitis and 1 with cirrhosis had experienced drug abuse. At the end of follow-up, 15 of the 89 initially HBeAg-positive patients and 2 of 8 initially HBeAg-negative children had cleared hepatitis B surface antigen. In conclusion, the overall prognosis for chronic hepatitis B in horizontally infected Caucasian children is favorable; however, some patients progress to HCC and HBeAg-negative hepatitis. Long-term monitoring is important, as is counseling on cofactors of liver damage, such as alcohol and drug abuse.
Fifth Medical Clinic, University of Padova, Italy. flavia.bortolotti@unipd.it
Flavia
F
Bortolotti
Maria
M
Guido
Samuela
S
Bartolacci
Paolo
P
Cadrobbi
Carlo
C
Crivellaro
Franco
F
Noventa
Giulia
G
Morsica
Maria
M
Moriondo
Angelo
A
Gatta
D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000209:etiology; D002353:Carrier State; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000097:blood / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000276:immunology*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis
D006513:Hepatitis B e Antigens