Phenotypes of chronic hepatitis B in children from a large North American cohort

KB Schwarz, M Lombardero… - Journal of pediatric …, 2019 - journals.lww.com
KB Schwarz, M Lombardero, AM Di Bisceglie, KF Murray, P Rosenthal, SC Ling
Journal of pediatric gastroenterology and nutrition, 2019journals.lww.com
Objective: The aim of the study was to define chronic HBV phenotypes in a large, cohort of
United States and Canadian children utilizing recently published population-based upper
limit of normal alanine aminotransferase levels (ULN ALT), compared with local laboratory
ULN; identify relationships with host and viral factors. Background: Chronic hepatitis B virus
(HBV) infection has been characterized by phases or phenotypes, possibly associated with
prognosis and indications for therapy. Methods: Baseline enrollment data of children in the …
Abstract
Objective:
The aim of the study was to define chronic HBV phenotypes in a large, cohort of United States and Canadian children utilizing recently published population-based upper limit of normal alanine aminotransferase levels (ULN ALT), compared with local laboratory ULN; identify relationships with host and viral factors.
Background:
Chronic hepatitis B virus (HBV) infection has been characterized by phases or phenotypes, possibly associated with prognosis and indications for therapy.
Methods:
Baseline enrollment data of children in the Hepatitis B Research Network were examined. Phenotype definitions were inactive carrier: HBeAg-negative with low HBV DNA and normal ALT levels; immune-tolerant: HBeAg-positive with high HBV DNA but normal ALT levels; or chronic hepatitis B: HBeAg-positive or-negative with high HBV DNA and abnormal ALT levels.
Results:
Three hundred seventy-one participants were analyzed of whom 274 were HBeAg-positive (74%). Younger participants were more likely be HBeAg-positive with higher HBV DNA levels. If local laboratory ULN ALT levels were used, 35% were assigned the immune tolerant phenotype, but if updated ULN were applied, only 12% could be so defined, and the remaining 82% would be considered to have chronic hepatitis B. Among HBeAg-negative participants, only 21 (22%) were defined as inactive carriers and 14 (14%) as HBeAg-negative chronic hepatitis B; the majority (61%) had abnormal ALT and low levels of HBV DNA, thus having an indeterminant phenotype. Increasing age was associated with smaller proportions of HBeAg-positive infection.
Conclusions:
Among children with chronic HBV infection living in North America, the immune tolerant phenotype is uncommon and HBeAg positivity decreases with age.
Lippincott Williams & Wilkins