Related Experiment Video

Updated: May 13, 2026

Analysis of HBV-Specific CD4 T-cell Responses and Identification of HLA-DR-Restricted CD4 T-Cell Epitopes Based on a Peptide Matrix
10:37

Analysis of HBV-Specific CD4 T-cell Responses and Identification of HLA-DR-Restricted CD4 T-Cell Epitopes Based on a Peptide Matrix

Published on: October 20, 2021

Clinical Course and Outcomes of Paediatric Chronic Hepatitis B: Insights From a Multicenter Longitudinal Cohort of

Roberto Privato1,2, Michele Pinon3, Valentina Buccella4

  • 1Meyer Children's Hospital IRCCS, Pediatric Unit, Florence, Italy.

Journal of Viral Hepatitis
|May 12, 2026
PubMed

Insights

Chronic hepatitis B virus (HBV) infection in children shows spontaneous HBeAg seroconversion in over half of cases, particularly with higher ALT levels. Adult classification systems are limited, necessitating pediatric-specific management strategies.

Area of Science:

  • Hepatology
  • Virology
  • Pediatric Gastroenterology

Background:

  • Chronic hepatitis B virus (HBV) infection in children has an incompletely understood natural history.
  • Current adult-derived classification systems may not accurately reflect disease progression in pediatric populations.

Purpose of the Study:

  • To characterize disease progression in pediatric chronic HBV infection.
  • To evaluate the applicability of adult-derived classification systems (EASL 2017).
  • To identify predictors of hepatitis B e-antigen (HBeAg) seroconversion and assess treatment needs.

Main Methods:

  • Multicenter, retrospective cohort study of 248 children (0-18 years) with chronic HBV.
  • Analysis of spontaneous HBeAg seroconversion rates and predictors.
  • Assessment of EASL 2017 criteria applicability and WHO 2024 treatment guidelines.

Main Results:

  • HBeAg seroconversion occurred in 52% of children, associated with higher baseline ALT levels but not HBV DNA levels.
  • 45% of children were unclassifiable by EASL 2017 criteria at baseline.
  • Seroconversion was less frequent in children of Asian origin.
  • Retrospective application of WHO 2024 guidelines indicated 33% met treatment criteria, yet most did not receive therapy.

Conclusions:

  • Adult classification systems have limitations in pediatric chronic HBV management.
  • Higher ALT levels are a significant predictor of spontaneous HBeAg seroconversion in children.
  • A cautious clinical approach to antiviral therapy may be warranted due to high spontaneous viral control rates.
  • Paediatric-specific management frameworks and prospective studies are needed to optimize treatment strategies.

Keywords:
antiviral treatmentschildrenchronic hepatitis Bhepatitis B virus

Related Concept Videos

Viral Hepatitis I: Introduction01:28

Viral Hepatitis I: Introduction

Viral hepatitis is an inflammatory condition of the liver caused by infection with hepatotropic viruses, most commonly hepatitis A, B, C, D, and E. Despite variations in structure and transmission, all viruses mentioned infect hepatocytes and provoke immune responses that can hinder liver function. Additionally, some non-hepatotropic viruses can also lead to hepatic inflammation.Hepatitis A VirusHepatitis A virus (HAV) is transmitted through the fecal–oral route, typically by ingestion of food...
Hepatitis01:25

Hepatitis

Hepatitis is an inflammatory condition of the liver most commonly caused by hepatotropic viruses (A–E), though non-infectious causes such as alcohol and drugs also exist.Hepatitis AHepatitis A virus (HAV) is a non-enveloped RNA virus of the Picornaviridae family. It is primarily transmitted via the fecal-oral route, typically through ingestion of contaminated food or water. After ingestion, HAV enters the bloodstream through the oropharynx or intestinal epithelium and reaches the liver. The...
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...