Chronic Hepatitis B in Children Admitted to a Tertiary Hospital in Türkiye: A 23-Year Observational Study

Hepatitis B virus infection remains a global public health concern despite the availability of an effective vaccine. In this study, we aimed to evaluate the demographic, clinical, diagnostic, treatment characteristics, and prognosis of pediatric patients diagnosed with chronic hepatitis B infection. Under the age of 18 who were diagnosed with chronic hepatitis B and followed up between 1999 and 2022 were included in this study. In our study, patient data were evaluated retrospectively. The hepatitis B clinical phases of the patients were defined. Patients who received treatment were classified into the following groups: interferon monotherapy; interferon plus lamivudine combination therapy; lamivudine; adefovir; tenofovir disoproxil fumarat; and entecavir. Patients who received treatment were evaluated in terms of virological response, HBeAg/HbsAg seroconversion development rate, and biochemical response. The study included 343 pediatric patients, 216 (63%) of whom were male, with a median diagnosis age of 10 years (min 6 months-max 17 years). One hundred and twenty-two (35.6%) patients had spontaneous seroconversion for HBeAg. Liver biopsy was performed in 150 (43.7%) patients for whom treatment was planned. Among those who had a biopsy, only 12 (8%) did not have fibrosis. In patients who underwent liver biopsy, 66 (44%) had grade 1, 22 (14.6%) grade 2, 46 (30.7%) grade 3, 1 (0.7%) grade 5, and 1 (0.7%) grade 6 fibrosis. Antiviral treatment was administered to 150 patients (43.7%). The virological response rate was 70% in patients receiving interferon alpha-2b monotherapy and 50% in those receiving tenofovir disoproxil fumarat and entecavir. The HBeAg seroconversion rate was 66% in patients receiving interferon alpha-2b monotherapy, 43.8% in those receiving tenofovir disoproxil fumarate, and 33.3% in those receiving entecavir. In our study, cirrhosis developed in 4 patients (1.2%) and hepatocellular cancer in 1 patient (0.3%). In our study, a significant proportion of treatment-naïve children exhibited moderate-to-severe liver fibrosis, highlighting the need for close monitoring and timely interventions; although current therapies achieve high response rates, more effective curative treatments are needed to prevent disease progression in pediatric hepatitis B.