Open AccessNatural History of Chronic Hepatitis B Virus Infection in Children of Different Ethnic Origins: A Cohort Study with Up to 12 Years' Follow‐up in Northern Greece
Author(s) -
Zacharakis George,
Koskinas John,
Kotsiou Stamatia,
Pouliou Evaggelia,
Papoutselis Menelaos,
Tzara Fevronia,
Vafeiadis Nikolaos,
Maltezos Eustratios,
Archimandritis Athanasios,
Papoutselis Kostantinos
Publication year - 2007
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/01.mpg.0000243438.47334.07
Subject(s) - medicine , seroconversion , hbeag , hbsag , hepatitis b virus , serology , natural history , transmission (telecommunications) , hepatitis b , cohort , gastroenterology , genotype , virology , immunology , virus , antibody , gene , biology , biochemistry , electrical engineering , engineering
Aim: To investigate the mode of transmission and the natural history of chronic hepatitis B virus (HBV) infection in children of different ethnicities in Greece. This study was part of the Interreg I‐II EC project. Patients and Methods: One hundred seventy‐three hepatitis B surface antigen (HBsAg)(+) carriers, median age 6.9 (5–12) y, were prospectively followed‐up for a mean period of 5.3 (1–12) y for serological markers of HBV infection, serum alanine aminotransferase (ALT), HBV‐DNA, α‐fetoprotein levels and ultrasonography. Results: Vertical transmission predominates (61.8%) in Moslem children and horizontal (44%) in those born in Russia. At entry, 73 of 173 (42%) HBsAg(+) genotype D children were hepatitis B e antigen (HBeAg)(+), ranging from 27% to 67% among ethnic groups; 55 of 173 (32%) had ALT > 2 × upper normal limit (UNL), ranging from 21% to 39%. Of 100 anti‐HBe(+) children, 85 (85%) were inactive carriers. During the follow‐up period, seroconversion to anti‐HBe was observed in 40 of 73 (55%) children with an annual rate of 11%; 35 of 40 (87.5%) had biochemical remission, and 28 of 35 (80%) lost HBV‐DNA. In the anti‐HBe(+) group, 27 of 100 (27%) lost HBV‐DNA and 9 of 100 (9%) lost HBsAg. The annual seroconversion rate for HBeAg was significantly lower: in children with vertical transmission compared with horizontal (7.7% vs 14.8%, respectively, P < 0.001) and in Muslim children compared with both Christian children and those born in Russia (8.6% vs 12%, respectively, P < 0.001). No differences were found among the ethnic groups after adjusting for the mode of infection. Two of 173 children had progression of liver disease. Conclusions: The differences in HBeAg(+) status and seroconversion rate among the ethnic groups are related to the time/mode of HBV infection. The majority of children who developed anti‐HBe immunity had biochemical remission, and a substantial number of the inactive carriers lost viremia during the observation period of up to 12 y.