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[The course and outcome of chronic hepatitis B in children]
Insights
Chronic hepatitis B (CHB) in children often shows mild symptoms when HBe-antigen positive. Long-term observation shows seroconversion to anti-HBe improves liver health, indicating minimal need for drug therapy.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Virology
Context:
- Chronic hepatitis B (CHB) affects children aged 1-14 years.
- Diagnosis confirmed by clinical, laboratory, and liver biopsy data.
- Study included 98 children over 1-6 years.
Purpose:
- To investigate the clinical course and outcomes of CHB in children.
- To analyze the significance of HBe-antigenemia and seroconversion.
- To determine the necessity of active drug therapy for pediatric CHB.
Summary:
- CHB with HBe-antigenemia presents with mild symptoms and enzymic flares without jaundice.
- Persistent HBs-antigenemia leads to seroconversion (HBeAg to anti-HBe), improving liver activity.
- Seroconversion and clinical improvement occur between 1-6 years, independent of initial hepatitis activity.
- Increased observation time (over 5 years) correlates with a 90% rate of anti-HBe appearance.
Impact:
- CHB in children generally follows a benign course, especially with HBe-antigenemia.
- Long-term monitoring is crucial for managing pediatric CHB.
- Findings suggest that active drug therapy may not be necessary for most CHB pediatric cases, emphasizing observation.
Abstract:
Overall 98 children aged 1 to 14 years suffering from chronic hepatitis B (CHB) were followed up clinically for 1 to 6 years. CHB was diagnosed on the basis of the clinical and laboratory data. In the majority of the children, the diagnosis was verified by the results of a histological study of liver biopsy specimens. Chronic active hepatitis (CAH), was revealed in 27 children, chronic persistent hepatitis (CPH) in 31. CHB was marked by the presence of HBe-antigenemia in 89 patients (90.8%). The studies have demonstrated that CHB associated with HBe-antigenemia runs its course with insignificant clinical manifestations and enzymic exacerbations without jaundice. In the presence of persistent HBs-antigenemia, the natural course of CHB (in CAH and CPH) is characterized by seroconversion (from HBeAg to anti-HBe) with a simultaneous decrease and normalization of aminotransferase activity and a reduction of the pathological process activity in the liver (transformation of CAH to CPH). Seroconversion and clinico-biochemical amelioration supervene at different observation periods (after 1-6 years) and do not depend on the initial activity of hepatitis. As the observation period increases, the rate of anti-HBe appearance in the blood rises, amounting to 90% with the observation period exceeding 5 years. The conclusion is made that CHB patients do not need active drug therapy but require long and permanent observation.