TY - JOUR
T1 - Chronic Hepatitis Is Common and Often Untreated Among Children with Hepatitis B Infection in the United States and Canada
AU - Hepatitis B Research Network (HBRN)
AU - Ling, Simon C.
AU - Lin, Hsing Hua S.
AU - Murray, Karen F.
AU - Rosenthal, Philip
AU - Mogul, Douglas
AU - Rodriguez-Baez, Norberto
AU - Schwarzenberg, Sarah Jane
AU - Teckman, Jeffrey
AU - Schwarz, Kathleen B.
AU - Li, Hongxia
AU - Anders, Robert
AU - Imteyaz, Hejab
AU - Lee, Peter
AU - Oshima, Kiyoko
AU - Kafka, Kim
AU - Islam, Naureen
AU - Riggs, Shannon M.
AU - Nagy, Rosemary A.
AU - Cerkoski, Jacki
AU - Hau, Athena
AU - Cui, Daniel
AU - Rodgers-Augustyniak, Laurie A.
AU - Montanye, Shirley
AU - Feier, Natasha
AU - Feier, Joel
AU - Langlois, Camille
AU - Cooper, Kara L.
AU - Hoofnagle, Jay H.
AU - Sherker, Averell H.
AU - Doo, Edward
AU - Torrance, Rebecca J.
AU - Hall, Sherry R.
AU - Averbach, Frani
AU - Haller, Tamara
AU - Hardison, Regina
AU - Kelley, Stephanie
AU - Lalama, Christina M.
AU - Lawlor, Sharon
AU - Lombardero, Manuel
AU - Pelesko, Andrew
AU - Stoliker, Donna
AU - Weiner, Melissa
AU - Zadorozny, Ella
AU - Zhao, Qian
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/10
Y1 - 2021/10
N2 - 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.
AB - 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.
KW - alanine aminotransferase
KW - clinical outcomes
KW - entecavir
KW - interferon
KW - lamivudine
KW - phenotype
KW - platelet count
KW - vertical transmission
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U2 - 10.1016/j.jpeds.2021.05.035
DO - 10.1016/j.jpeds.2021.05.035
M3 - Article
C2 - 34022250
AN - SCOPUS:85109002240
SN - 0022-3476
VL - 237
SP - 24-33.e12
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -