Chronic Hepatitis Is Common and Often Untreated Among Children with Hepatitis B Infection in the United States and Canada - 22/09/21

Doi : 10.1016/j.jpeds.2021.05.035

Simon C. Ling, MBChB ^1,^⁎ , Hsing-Hua S. Lin, PhD ², Karen F. Murray, MD ³, Philip Rosenthal, MD ⁴, Douglas Mogul, MD ⁵, Norberto Rodriguez-Baez, MD ⁶, Sarah Jane Schwarzenberg, MD ⁷, Jeffrey Teckman, MD ⁸, Kathleen B. Schwarz, MD ⁵
for the
Hepatitis B Research Network (HBRN)
Hongxia Li, MBBS, MS, Robert Anders, MD, PhD, Hejab Imteyaz, Peter Lee, MD, Kiyoko Oshima, MD, Kim Kafka, RN, Naureen Islam, BS, Shannon M. Riggs, LPN, AS, Rosemary A. Nagy, RDN, LD, MBA, Jacki Cerkoski, RN, MSN, Athena Hau, BSc, Daniel Cui, PhD, Laurie A. Rodgers-Augustyniak, RN, Shirley Montanye, RN, Natasha Feier, MS, Joel Feier, BS, Camille Langlois, MS, Kara L. Cooper, Jay H. Hoofnagle, MD, Averell H. Sherker, MD, Edward Doo, MD, Rebecca J. Torrance, RN, MS, Sherry R. Hall, MS, Frani Averbach, MPH, Tamara Haller, Regina Hardison, MS, Stephanie Kelley, MS, Christina M. Lalama, MS, Sharon Lawlor, MBA, Manuel Lombardero, MS, Andrew Pelesko, BS, Donna Stoliker, Melissa Weiner, MPH, Ella Zadorozny, MS, Qian Zhao, PhD

¹ Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
² Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
³ Department of Pediatrics, University of Washington, Seattle, WA
⁴ Department of Pediatrics, UCSF, San Francisco, CA
⁵ Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD
⁶ Department of Pediatrics, UT Southwestern, Dallas, TX
⁷ Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
⁸ Department of Pediatrics, Saint Louis University, Saint Louis, MO

^∗Reprint requests: Simon C. Ling, MBChB, Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, CanadaDivision of Gastroenterology, Hepatology & NutritionThe Hospital for Sick Children555 University AveTorontoOntarioM5G 1X8Canada

Abstract

Objective

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

Study design

This was 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 upper limit of normal) were present in 72% at last evaluation, including in 60% of children with loss of hepatitis B e antigen during follow-up and 70% of those who were hepatitis B e antigen negative at baseline. Significant ALT flares (male patients ≥400 U/L, female patients ≥350 U/L) occurred in 13 children. Of 129 children who fulfilled the American Association for the Study of Liver Diseases 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.

Conclusions

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.

Le texte complet de cet article est disponible en PDF.

Keywords : clinical outcomes, vertical transmission, phenotype, alanine aminotransferase, platelet count, entecavir, interferon, lamivudine

Abbreviations : AASLD, AFP, ALT, AST, CALIPER, HBeAg, HBRN, HBsAg, HBV, HCC, ULN

Plan

Serologic and Virologic Outcomes

Funding and conflicts of interest disclosure statements available at www.jpeds.com.

Export

Vol 237

P. 24 - octobre 2021 Retour au numéro

Article précédent

50 Years Ago in The Journal of Pediatrics : The Pathologic Behavior of Adenoviruses
Sarah S. Long

| Article suivant

Bloody Diarrhea and Shiga Toxin–Producing Escherichia coli Hemolytic Uremic Syndrome in Children: Data from the ItalKid-HUS Network
Gianluigi Ardissino, Chiara Vignati, Carla Masia, Valentina Capone, Rosaria Colombo, Francesca Tel, Laura Daprai, Sara Testa, Antonella Dodaro, Fabio Paglialonga, Mario Luini, Maurizio Brigotti, Damiano Picicco, Carlo Baldioli, Franca Pagani, Rossella Ceruti, Paola Tommasi, Ilaria Possenti, Donata Cresseri, Dario Consonni, Giovanni Montini, Milena Arghittu, ItalKid-HUS Network

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

connectez-vous ou créez un compte

Chronic Hepatitis Is Common and Often Untreated Among Children with Hepatitis B Infection in the United States and Canada - 22/09/21

Abstract

Objective

Study design

Results

Conclusions

Plan

Export citations

Fichier

Contenu

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL