Related Experiment Video
Updated: Dec 10, 2025
"Liver-on-a-Chip" Cultures of Primary Hepatocytes and Kupffer Cells for Hepatitis B Virus Infection
Published on: February 19, 2019
Chronic hepatitis B in children, report of a single-centre longitudinal study on 152 children
Olivia C Arnone1, Daniele Serranti1, Elisa Bartolini1
1Liver Unit, Meyer Children's University Hospital, University of Florence, Firenze, Italy.
Insights
This study tracked chronic hepatitis B virus (HBV) infection in children, finding that adult EASL guidelines are not suitable for pediatric cases. Factors like elevated ALT and lower HBV DNA influenced HBeAg seroconversion in children.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Virology
Background:
- Chronic hepatitis B virus (HBV) infection is a global health concern.
- Understanding the natural history of HBV in children is crucial for management.
- Current adult classification systems may not accurately reflect pediatric HBV infection phases.
Purpose of the Study:
- To describe the natural history of chronic HBV infection in untreated children.
- To evaluate the applicability of the European Association for the Study of Liver (EASL) adult classification to pediatric HBV infection.
- To identify factors influencing HBeAg seroconversion in children with chronic HBV.
Main Methods:
- Prospective study of 152 untreated children with chronic HBV infection.
- Follow-up duration ranged from 7 to 232 months.
- Analysis of baseline and end-of-observation HBeAg, HBsAg, and alanine aminotransferase (ALT) levels, alongside HBV DNA levels and ethnicity.
Main Results:
- At baseline, 82.2% of children were HBeAg positive and 15.8% were HBeAg negative, with most having abnormal ALT levels.
- HBeAg seroconversion occurred in 40.7% of HBeAg-positive children, with elevated ALT, lower HBV DNA, and Asian ethnicity as predisposing factors.
- The EASL adult classification criteria were not applicable to 43.3% at baseline and 43.5% at the end of observation, necessitating an 'undetermined phenotype' category.
Conclusions:
- The natural history of chronic HBV infection in children differs from adults.
- The current EASL classification for adult HBV infection is not satisfactory for use in children.
- Further research is needed to develop age-appropriate classification systems for pediatric HBV infection.
Abstract:
The aims of this prospective study were as follows: (1) to describe the natural history of chronic hepatitis B virus (HBV) infection in a large cohort of untreated children followed at a single centre and (2) to evaluate whether or not the new European Association for the Study of Liver (EASL) classification for the phases of HBV infection in adults can be used for children. All children who presented at the Liver Unit of our hospital from 1 January 1987 to 31 December 2019 and were diagnosed with chronic HBV infection were enrolled. The final sample consisted of 152 children. The median duration of the follow-up was 83 months (range 7-232). At baseline, 125 patients (82.2%) were HBeAg positive (85.3% abnormal alanine aminotransferase (ALT) levels), and 24 (15.8%) were HBeAg-negative (93.3% abnormal ALT). At the end of the observation period, 62 of the HBeAg-positive patients (40.7%) achieved HBeAg seroconversion (median age 9.45 years, range 0.8-19) and 2 (1.4%) achieved HBsAg seroconversion. Elevated ALT serum levels at baseline (P = .011), lower baseline HBV DNA levels (P < .001) and Asian ethnicity (P = .0001) were identified as predisposing factors towards HBeAg seroconversion. EASL criteria could not be applied to 43.3% and 43.5% of the children at baseline and at end of observation, respectively, that were grouped into an undetermined phenotype category. According to the results of the present study, the new EASL guidelines for adults with HBV infection cannot be applied in a satisfactory manner in children.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test