Serological, biochemical and virological profile of chronic hepatitis B virus infection in children

Introduction: The course of chronic hepatitis B (CHB) depends on the age at which the infection took place. There are four phases of hepatitis B virus (HBV) infection: tolerance, control, clearance and reactivation of infection.

Aim: Retrospective assessment of effectiveness of treatment in children with HBV, and the current biochemical, serological and virological factors, including the infection stage.

Material and methods: The study was conducted on 114 pa­tients (76 boys). The inclusion criteria were: the age of the patient up to 18, HBsAg(+). Patient interview regarding the probable source of infection, the age at which the infection was discovered, and the effectiveness of the treatment methods so far, were examined. The current levels of HBV-DNA, ALT and serological infection markers were evaluated.

Results: All patients were infected with HBV in the first months of their lives. HBeAg was found in 20/114 (17.5%) of the examined patients; no antigen was found in 94/114 (82.5%). Seroconversion in the HBe/antiHBe system happened spontaneously in 57 subjects in the HBeAg(–) group and in 37 among the 57 patients treated with IFN- and/or LAM. Average ALT activity in 94 patients with HBeAg(–) was 27 IU/ml. 86 subjects fulfilled the criteria for the control phase, 6 for the clearance phase, and one for the reactivation of infection. In the HBeAg(+) group the average ALT was 63 IU/ml, 1 patient remained in the tolerance phase, 1 in the control phase, and 18 in the clearance phase. Viraemia >105 copies/ml was found in 90% of the HBeAg(+) patients and in 6.4% of the HBeAg(–) patients. HBeAg(–) patients with spontaneous seroconversion showed statistically lower values of viraemia in comparison to patients with seroconversion after treatment, mean 7 326 vs. 30 463 copies/ml. No differences in ALT levels in the above groups were found, mean 26 vs. 24 IU/ml.

Conclusions: Despite the fact that patients with HBeAg(–) show lower viraemia and lower ALT activity in comparison to HBeAg(+), 23% of that infected group fulfil the criteria of the immunological clearance and reactivation phases, and need further antiviral treatment.