Children with Chronic Hepatitis B in the United States and Canada

Abstract

Objectives: To test the hypothesis that children with chronic hepatitis B living in the US and Canada would have international origins and characteristic hepatitis B virus (HBV) genotypes and laboratory profiles.

Study design: Clinical characteristics of children enrolled in the Hepatitis B Research Network were collected from 7 US and Canadian centers.

Results: Children (n = 343) with an age range of 1.0-17.8 years were enrolled; 78% of the children were Asian, 55% were adopted, and 97% had international origins with either the child or a parent born in 1 of 31 countries. The majority had HBV genotype B (43%) or C (32%), and the remainder had genotype A (5%), D (16%), E (4%), or multiple (<1%). Children with genotype B or C were more likely to be Asian (98% and 96%), more consistently hepatitis B envelope antigen positive (95% and 82%), had higher median HBV DNA levels (8.2 and 8.3 log10 IU/mL), and less frequently had elevated alanine aminotransferase values (43% and 57%) compared with children with other genotypes. The percentage of hepatitis B envelope antigen positivity and of those with HBV DNA ≥6 log₁₀ IU/mL declined with age.

Conclusions: The majority of children in the Hepatitis B Research Network have HBV genotypes that reflect their international origins. Clinical and laboratory data differ substantially by patient age and HBV genotype. Use of these data can help drive the development of optimal strategies to manage and treat children with chronic hepatitis B.

Figure 1

Enrollment diagram

Figure 2

A, Relationship between age, HBeAg and ALT levels demonstrating an age-related decline in the percent of participants who were HBeAg positive with ALT >1 x ULN and a corresponding increase in those who were negative for HBeAG with normal ALT. B, Relationship between age and HBV DNA levels demonstrating an age-related decrease in the percent of participants with HBV DNA >6 log ₁₀ IU/mL and a corresponding increase in those with HBV DNA <3 and 3 – < 6 log ₁₀ IU/mL

Figure 2

A, Relationship between age, HBeAg and ALT levels demonstrating an age-related decline in the percent of participants who were HBeAg positive with ALT >1 x ULN and a corresponding increase in those who were negative for HBeAG with normal ALT. B, Relationship between age and HBV DNA levels demonstrating an age-related decrease in the percent of participants with HBV DNA >6 log ₁₀ IU/mL and a corresponding increase in those with HBV DNA <3 and 3 – < 6 log ₁₀ IU/mL

Fig 3

Pediatric Genotype by Birthplace illustrating a predominance of B and C genotypes among those born in the US and Canada, mirroring the genotypes that predominate among those born in Asia. Genotype D is most prevalent in European-born children, and Genotype E is most common in African-born children.