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Clinical and histological outcome after hepatitis B e antigen to antibody seroconversion in children with chronic
M Ruiz-Moreno1, M Otero, A Millán
1Department of Paediatrics, Fundación Jiménez Díaz, Clínica Puerta de Hierro, Madrid, Spain.
Insights
Long-term follow-up of children with chronic hepatitis B post-seroconversion shows stable alanine aminotransferase (ALT) levels and significant liver histology improvement. No difference in outcomes was observed between treated and untreated children.
Area of Science:
- Pediatric Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis B in children requires long-term monitoring.
- Data on outcomes after hepatitis B e antigen seroconversion in pediatric populations are limited.
Purpose of the Study:
- To describe the long-term evolution of children with chronic hepatitis B after seroconversion.
- To evaluate histological changes in liver biopsies before and after seroconversion.
Main Methods:
- Follow-up of 103 children with anti-HBe and normal ALT levels for a mean of 6.3 years.
- Analysis of paired liver biopsies (pre- and post-seroconversion) in 83 cases.
- Detection of hepatitis B virus DNA using polymerase chain reaction.
Main Results:
- Most children (79%) maintained normal ALT levels.
- Significant histological improvement was observed in liver biopsies post-seroconversion (P <.001).
- Histological improvement correlated with time since seroconversion (P <.001).
Conclusions:
- Seroconversion and ALT normalization are stable in pediatric chronic hepatitis B.
- Liver histology significantly improves post-seroconversion, suggesting routine follow-up biopsies may be unnecessary.
- No significant long-term outcome differences were found between treated and untreated children.
Abstract:
Data regarding the outcome of children with chronic hepatitis B after seroconversion are scarce. We describe the long-term evolution of these patients. One hundred and three children with antibody against hepatitis B e antigen and normal alanine aminotransferase (ALT) levels were followed for 0.6 to 12.5 years (mean, 6.3 years). Paired liver biopsies (before and after seroconversion) were available in 83 cases. Final biopsies were obtained 0.5 to 12.5 years (mean, 4.5 years) after seroconversion. ALT levels remained normal in most of the children (79%) throughout the follow-up. All children, except five who lost hepatitis B surface antigen, had serum viral DNA detected by polymerase chain reaction. When comparing baseline and final liver biopsies, a significant improvement (P <.001) was found in the histological activity index and in the necrosis, cytolysis, inflammation, and fibrosis scores. The histological diagnosis improvement in the final biopsy was significantly related (P <.001) to the time from seroconversion to the biopsy performance. All children had viral DNA on their final liver biopsy. In summary, seroconversion and ALT normalization are quite stable findings in children, and no differences in the long-term outcome between treated and untreated children were found. In light of the histological outcome, it seems unnecessary to perform a follow-up liver biopsy in these cases.