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Serological and histological follow up of chronic hepatitis B infection
M Ruiz-Moreno1, T Camps, J G Aguado
1Department of Paediatrics, Fundación Jiménez Diaz, Madrid.
Insights
This study followed 90 children with chronic hepatitis B infection for 3 years. HBeAg-positive children showed more severe liver damage and higher ALT levels, with improvement seen after seroconversion to anti-HBe.
Area of Science:
- Pediatric Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B virus (HBV) infection in children requires understanding its long-term clinical, serological, and morphological changes.
- Identifying factors influencing disease progression is crucial for effective management.
Purpose of the Study:
- To prospectively investigate the evolution of chronic hepatitis B virus infection in a pediatric cohort.
- To correlate serological markers (HBeAg, anti-HBe, HBV DNA) with clinical and histological findings.
Main Methods:
- Prospective follow-up of 90 children with chronic HBV infection for a mean of 3 years.
- Assessment of clinical status, serological markers (HBeAg, anti-HBe, HBV DNA), alanine aminotransferase (ALT) levels, and liver histology.
- Monitoring of seroconversion rates and changes in liver enzyme activity and histology over time.
Main Results:
- HBeAg-positive children exhibited higher ALT levels and more severe liver histology compared to anti-HBe-positive children.
- An annual seroconversion rate of 14% was observed.
- Elevated ALT activity preceded anti-HBe appearance by approximately 13 months in 85% of cases.
- HBeAg persistence correlated with increased histological activity, while anti-HBe seroconversion was associated with amelioration of liver damage.
Conclusions:
- HBeAg positivity in childhood chronic hepatitis B is linked to significant liver inflammation and damage.
- Seroconversion from HBeAg to anti-HBe marks a turning point, often accompanied by normalization of ALT levels and improvement in liver histology.
- Monitoring ALT flares preceding seroconversion is important for understanding disease dynamics in pediatric HBV infection.
Abstract:
In order to study the clinical, serological, and morphological evolution of chronic hepatitis B virus infection in childhood, a prospective study has been carried out. A total of 90 children with a chronic infection were followed up for a mean (SD) of 3 (1.8) years. At the beginning of the study, 61 children were asymptomatic and 77 were household contacts of chronic carriers. Serologically 77 were hepatitis B e antigen (HBeAg) positive and 71 of them were positive to hepatitis B virus DNA. The mean alanine aminotransferase activities were higher among HBeAg positive patients than in antihepatitis B e (anti-HBe) positive ones. The most severe histological damage was also found among HBeAg positive patients. The annual seroconversion rate was 14%. A significant increase in the alanine aminotransferase activity was observed 13 (5.6) months before appearance of anti-HBe in the 85% of cases. Among anti-HBe positive patients, the alanine aminotransferase activities were normal in all except three (19%), two of whom had intrahepatic delta antigen. An increase in the histological activity was observed among patients who maintained HBeAg presence while an amelioration of liver damage was observed in anti-HBe carriers.