Histology and Clinical Characteristics of Asymptomatic Treatment-naïve Children with Chronic Hepatitis B in Shanghai China

Abstract

BACKGROUND & AIMS: Chronic hepatitis B (CHB) virus infection is a major cause of morbidity and mortality. We aim to investigate the association between hepatic histology and clinical characteristics in asymptomatic treatment-naïve children chronically infected with hepatitis B virus (HBV) in Shanghai China. METHODS: Liver biopsies of 278 asymptomatic treatment-naïve children with chronic hepatitis B virus infection were scored for inflammation and fibrosis, and correlated with clinical and laboratory data. RESULTS: The clinical, virologic and pathologic features of chronic HBV infection were studied in 278 treatment-naïve children from Shanghai, China, of who were all asymptomatic. And 177 (63.7%) of the children were male. Sera from mothers of 277 of these children were HBsAg positive. Up to 87.4% of subjects were hepatitis B e antigen-positive at the time of the biopsy. The median age at biopsy was 5.1 years (interquartile range 2.8-8.4 years). HBV DNA levels were generally high (mean 7.4 log10 IU/mL), as was serum alanine aminotransferase (median 105 U/L). Using the Ishak-modified histology activity index scoring system, no inflammation was seen in 2.9% cases, mild inflammation was in 22.3%, moderate in 73.4%, and severe in 1.4%. No fibrosis was seen in 11.5%, mild fibrosis in 32.7%, moderate fibrosis in 47.5%, and cirrhosis in 8.3%. When serum ALT level was < 80 (2×ULN) and > 80 U/L, the degree of inflammation (P<0.0001) and fibrosis stage (P<0.0001) had significant differences. Inflammation and fibrosis aggravated with ALT level increasing. Fibrosis stage had significant differences between age of <3 and >3 years (P<0.0001). Moderate fibrosis and cirrhosis rate was relatively higher in children aged <3 years at biopsy. No correlation was found between histological changes with gender, HBV genotypes or HBV DNA levels. CONCLUSION: Significantly wide range of inflammation and fibrosis is seen in asymptomatic treatment-naïve children with chronic hepatitis B in Shanghai China. Serum ALT >80 U/L may be a strong indicator of the degree of hepatic inflammation and severity of fibrosis. Moderate fibrosis and cirrhosis has already appeared in aged <3 years children.