Study: Chronic Hepatitis Is Common and Often Untreated Among
A Study was conducted to determine the outcomes of chronic hepatitis B virus (HBV) infection in a large, prospectively studied cohort of children that showed varied outcomes.

A prospective observational study of children with chronic HBV enrolled in 7 clinical centers and evaluated at baseline, weeks 24 and 48, and annually thereafter, with analysis of demographic, clinical, physical examination and blood test data.

--Among 362 children followed for a median of 4.2 years, elevated alanine aminotransferase (ALT) levels (more than 1 ULN) were present in 72% at last evaluation, including in 60% of children with loss of HBeAg during follow-up and 70% of those who were HBeAg negative at baseline.

--Significant ALT flares (males more than 400 U/L, females more than 350 U/L) occurred in 13 children.

--Of 129 children who fulfilled AASLD treatment criteria during follow-up, anti-HBV treatment was initiated in only 25. One child died (unrelated to liver disease), 1 developed cirrhosis, but no episodes of cirrhotic decompensation or hepatocellular carcinoma were observed.

--Decline in platelet count was inversely associated with ALT elevations.

In conclusion, many children with chronic HBV infection remained at risk of progressive liver disease due to active hepatitis, but significant clinical consequences such as cirrhosis, cancer, and death were uncommon in a cohort of children with chronic HBV infection.