Course of Chronic Hepatitis B in Children
Although children with chronic hepatitis B typically
experience relatively mild disease, some develop advanced
liver damage, according to a Polish study reported
in the December
2009 European Journal of Gastroenterology & Hepatology.
Out of 200 children studied, 4% had advanced fibrosis
or cirrhosis, and progression appeared to be related
to age at the time of infection.
Mozer-Lisewska from the University of Medical Sciences in Poznañ,
Poland, and colleagues conducted a study to assess inflammatory
activity, liver fibrosis,
and their relation to clinical data in children
with chronic hepatitis B who were not yet receiving antiviral
The study included 200 children with chronic hepatitis B, aged
1.5 to 18 years (mean 7.5 years), who were hospitalized before
liver biopsy between 1992 and 2003.
The investigators analyzed disease history and clinical data.
Necroinflammatory activity refers to degree of liver cell death
and inflammation, indicated by biopsy findings and elevations
in ALT and AST liver enzymes. Histopathological assessment,
or degree of fibrosis seen in a biopsy specimen, was based on
the modified Knodell staging system.
children (58%) were found have mild necroinflammatory activity
and 44 (22%) had was moderate activity.
children (47%) had minimal fibrosis (stage 1), 62 children
(31%) had moderate fibrosis (stage 2), and the remaining
8 children (4%) had severe fibrosis or cirrhosis (stage
activity was proportional to staging, and was significantly
higher in children with fibrosis stage 2 or higher.
hepatitis B early or "e" antigen (HBeAg) seroconversion
occurred in 30 of 200 children (15%), and was related to
shorter length of infection.
on these findings the study authors concluded, "Intensity
of liver injury in children with chronic hepatitis B varies
from minimal to marked necroinflammatory activity and fibrosis
varies from none to advanced."
"Progression of liver fibrosis seems to be proportional
to the age at infection," they continued. "ALT activity
appears to be higher in the children with significant (S2-S4)
fibrosis. Spontaneous hepatitis B early antigen seroconversion
is apparently related to the shorter length of infection and
higher ALT activity."
Department of Infectious Diseases and Child Neurology, University
of Medical Sciences, Poznañ, Poland.
Mozer-Lisewska, A Mania, W Sluzewski , and others. Factors influencing
clinical course and histological findings in children with chronic
hepatitis B. European Journal of Gastroenterology & Hepatology
21(12): 1400-1406 (Abstract).