title: Profile of chronic hepatitis B virus in children in India: experience with 116 children.
abstract: BACKGROUND
  Hepatitis B virus (HBV) infection in children is mostly asymptomatic and therefore the disease burden is likely to be under appreciated. There is limited information on the profile of chronic HBV infection in children from the Indian subcontinent.
  
  
  METHODS
  In 116 (male:female 89:27) children, aged <15 years, with persistent HBsAg positivity for more than 6 months, a clinical, biochemical, virological and histological assessment was carried out.
  
  
  RESULTS
  At presentation, 21.6% of children were symptomatic, with icterus in 12%. Features of decompensation such as ascites (7%) and gastrointestinal (GI) bleed (5%) were noted uncommonly. Five (4.3%) children had hepatocellular carcinoma (HCC) at presentation. Elevated alanine aminotransferase (ALT) was observed in 76% of subjects (median 61; range 14-815). A significantly higher proportion of children with hepatitis B early antigen (HbeAg) positive status had higher histological activity index (HAI) (84% vs 16%, P < 0.001) and fibrosis score (80% vs 20%, P = 0.007). A strong positive correlation was noted between aspartate aminotransferase (AST), ALT, HBV-DNA and histological severity of the disease (HAI > or =4, fibrosis > or =2). Median HBV-DNA levels were significantly higher in the HBeAg positive compared to the HBeAg negative group (25.6 vs 0.7 pg/mL, P = 0.004). Seventy-four percent of the mothers had evidence of past or present HBV infection.
  
  
  CONCLUSIONS
  Majority of the children with chronic HBV infection are asymptomatic at presentation. HBeAg positive status reflects histologically more severe disease, and a higher level of HBV-DNA. Almost two-thirds of the children may have acquired their HBV infection perinataly.
authors.affiliation: Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Satapathy
authors.forename: S
authors.initials: S
authors.lastname: Garg
authors.forename: R
authors.initials: R
authors.lastname: Chauhan
authors.forename: V
authors.initials: V
authors.lastname: Malhotra
authors.forename: P
authors.initials: P
authors.lastname: Sakhuja
authors.forename: B C
authors.initials: BC
authors.lastname: Sharma
authors.forename: S K
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000032:analysis*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens