https://pubmed.ncbi.nlm.nih.gov/34022250/ Hepatitis C

J Pediatr. 2021 May 19;S0022-3476(21)00458-3.
doi: 10.1016/j.jpeds.2021.05.035.Online ahead of print.

Chronic Hepatitis Is Common and Often Untreated Among Children With Hepatitis B Infection in the United States and Canada

Simon C Ling 1, Hsing-Hua S Lin 2, Karen F Murray 3, Philip Rosenthal 4, Douglas Mogul 5, Norberto Rodriguez-Baez 6, Sarah Jane Schwarzenberg 7, Jeffrey Teckman 8, Kathleen B Schwarz 5, Hepatitis B Research Network (HBRN)

Abstract

Objective: To determine the outcomes of chronic hepatitis B virus (HBV) infection in a large, prospectively studied cohort of children in the USA and Canada.

Study design: A prospective observational study of children with chronic HBV enrolled in 7 clinical centers and evaluated at baseline, weeks 24 and 48, and annually thereafter, with analysis of demographic, clinical, physical examination and blood test data.

Results: Among 362 children followed for a median of 4.2 years, elevated alanine aminotransferase (ALT) levels (>1 ULN) were present in 72% at last evaluation, including in 60% of children with loss of HBeAg during follow-up and 70% of those who were HBeAg negative at baseline. Significant ALT flares (males ≥400 U/L, females ≥350 U/L) occurred in 13 children. Of 129 children who fulfilled AASLD treatment criteria during follow-up, anti-HBV treatment was initiated in only 25. One child died (unrelated to liver disease), 1 developed cirrhosis, but no episodes of cirrhotic decompensation or hepatocellular carcinoma were observed. Decline in platelet count was inversely associated with ALT elevations.

Conclusion: In a cohort of children with chronic HBV infection in the US and Canada, many children remained at risk of progressive liver disease due to active hepatitis, but major clinical outcomes such as cirrhosis, cancer and death were rare. Many children who met criteria for treatment remained untreated.