Liver histology of treatment-naïve children with chronic hepatitis B virus infection in Shanghai China. (October 2022)

• Record Type: Journal Article
• Authors: Hu, Yao; Wu, Xia; Ye, Yingzi; Ye, Lijing; Han, Shuzhen; Wang, Xiaohong; Yu, Hui
• Is Part Of: International journal of infectious diseases. Volume 123(2022)
• Page Start: 112
• Page End: 118
• Publication Date: 2022-10
• Subjects: Children -- Treatment-naïve -- Chronic Hepatitis B virus infection -- Histology -- Pathology -- Clinical characteristics; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.08.017
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Demographic, clinical, and histological characteristics of 278 children with chronic hepatitis B. Serum alanine aminotransferase >80 U/l may strongly indicate hepatic inflammation and fibrosis. Moderate fibrosis and cirrhosis can appear in children aged 3 years or younger. Abstract: Objectives: Chronic hepatitis B (CHB) is associated with high morbidity and mortality. We aimed to investigate associations between hepatic histology and clinical characteristics in treatment-naïve children with CHB in Shanghai, China. Methods: The liver biopsy specimens of 278 treatment-naïve children with CHB virus infection were scored for inflammation and fibrosis, and correlations with clinical and laboratory data were determined. Results: CHB clinical, virologic, and pathologic features were studied in 278 treatment-naïve children (177 [63.7%] males) in Shanghai, China. Maternal sera were positive for hepatitis B surface antigen for 277 children. At biopsy, 87.4% of patients were hepatitis B e antigen–positive. The median age at biopsy was 5.1 years (interquartile range 2.8-8.4 years). Hepatitis B virus (HBV) deoxyribonucleic acid levels were generally high (mean 7.4 log10 IU/ml), as were levels of serum alanine aminotransferase (ALT, median 105 U/l). Using the Metavir histology activity index scoring system, no, mild, moderate, and severe inflammation were seen in 2.9%, 22.3%, 73.4%, and 1.4% of patients, respectively. No fibrosis, mild fibrosis, moderate fibrosis, and cirrhosis were seen in 11.5%, 32.7%, 47.5%, and 8.3% of patients, respectively. When the serum ALT level was ≤80 (two times the upper limit of normal) and >80 U/l, the inflammation score ( P <0.0001) was significantly different, and the fibrosis score was also significantly different ( P <0.0001). Inflammation and fibrosis were aggravated with increasing ALT levels. Fibrosis scores were significantly higher in children aged ≤3 than aged >3 years ( P <0.0001). The rates of moderate fibrosis and cirrhosis were higher in children aged ≤3 years at biopsy. No correlations were found between histologic changes and sex, HBV genotype, or HBV deoxyribonucleic acid level. Conclusion: Substantial heterogeneity in inflammatory and fibrotic levels was observed in treatment-naïve children with CHB in Shanghai, China. Serum ALT levels >80 U/l may be a strong indicator of the degree of hepatic inflammation and fibrosis severity. Moderate fibrosis and cirrhosis can appear in children aged 3 years or younger. Graphical abstract: Image, graphical abstract