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Longitudinal Immune Phenotype Assessment and Serological Outcome in Foreign-born Children With Chronic Hepatitis B
Emanuele Nicastro1, Benedetta Mangili1, Vania Giacomet2
1Department of Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo.
Insights
In foreign-born children with chronic hepatitis B virus (HBV) infection, ethnicity and immune status significantly impact seroconversion to hepatitis B e antibodies (SCHBe). Asian ethnicity was associated with a lower probability of SCHBe.
Area of Science:
- Pediatric Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B virus (HBV) infection in children born in HBV-endemic countries presents unique clinical challenges.
- Understanding the determinants of disease progression and treatment outcomes is crucial for effective management.
Purpose of the Study:
- To assess changes in clinical phenotype and identify factors influencing outcomes in children with chronic HBV infection.
- To investigate determinants of seroconversion to hepatitis B e antibodies (SCHBe) in this pediatric population.
Main Methods:
- A prospective observational study included 69 children with chronic HBV infection.
- Patients were categorized into immune-tolerant or immune-active groups based on transaminase levels and viral load.
- Exclusion criteria included liver fibrosis or need for antiviral treatment.
Main Results:
- Ethnicity was the sole independent predictor of SCHBe; Asian origin significantly reduced the odds of SCHBe (OR=0.24).
- Immune-active children had a higher rate of SCHBe (28%) compared to immune-tolerant children (11%).
- Viral genotype did not influence the outcome of SCHBe.
Conclusions:
- Immune status phenotype and ethnicity are key determinants of SCHBe in foreign-born children with chronic HBV infection.
- These findings highlight the importance of considering ethnic background in managing chronic HBV in pediatric populations.
Objectives:
The aim of the study was to assess changes in clinical phenotype, and identify determinants of outcome in children with chronic hepatitis B virus (HBV) infection born in HBV-endemic countries followed in 2 Italian tertiary care centers after immigration or adoption.
Methods:
A prospective observational study on hepatitis B e-antibodies-negative chronic hepatitis B children started on 2002. Patients with liver fibrosis, or those needing antiviral treatment were excluded. Immune active patients were defined those with raised transaminases (alanine aminotransferase > 40 IU/L), immune tolerants those having normal alanine aminotransferase, both exhibiting substantial viral replication (HBV DNA >2000 IU/mL).
Results:
Sixty-nine patients (44 boys, median age 4.7 years) had a median follow-up of 53 months. At entry, 18 (26%) children were immune tolerant, 47 (68%) immune active, and 4 had indeterminant immune status. At last follow-up, 14 (78%) of the immune-tolerant patients remained so, whereas only 23 (49%) of the immune active children maintained their initial immune phenotype. Seroconversion to hepatitis B e antibodies (SCHBe) occurred in only 2 (11%) immune tolerants, whereas 13 (28%) immune active patients achieved SCHBe.Ethnicity was the only feature independently correlated to SCHBe: Asian origin reduced by 4.1 times the probability of SCHBe (Asian vs other; odds ratio = 0.24 [95% confidence interval = 0.07-0.76]; P = 0.016) compared to other ethnicities, whereas viral genotype did not influence the outcome.
Conclusions:
Ethnicity and immune status phenotype against HBV, rather than HBV genotype, are the main determinants of SCHBe in foreign-born children with chronic HBV infection.
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