Clinical outcome of chronic hepatitis B in children during a long-term follow-up

Objectives. To evaluate the outcome of chronic hepatitis B in patients infected during childhood, over a 25-year period (1974-1999). Methods. We studied 48 patients with chronic hepatitis B, for at least 5 years. The patients were 28 males and 20 females, median age 6.1 years. At the first observation 45 patients were HBeAg+, 1 was HBeAg- HBeAb-, 2 were HBeAb+. One patient had cirrhosis. The patients were followed for an average period of 10 years and 7 months. Steroids and azathioprine were given to 16 of the patients treated from 1974 to 1987, α-IFN to 24 patients treated in the period 1988-1995, steroids and azathioprine and subsequently α-INF to 3 pts.; 5 patients were untreated. Results. Thirty-four of 46 (74%) patients seroconverted from HBeAg to HBeAb and remained stably HBVDNA-negative with normal transaminases during follow-up. Three patients cleared Hepatitis B surface antigen. No clinical worsening was observed in the patient with cirrhosis. During follow-up none of them presented hepatocarcinoma. There was no difference in seroconversion in the three groups of patients treated. Conclusions. In most patients, the outcome of chronic hepatis B presenting in childhood is favourable; a group of patients with persistent liver damage and active viral replication is at risk of disease progression.