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Chronic hepatitis B is usually a benign disease in Caucasian children;however,the long-term prognosis remains unsettled.This report describes the results of a 29-year longitudinal study including 99 white children with chronic hepatitis B,mainly acquired horizontally:91 were hepatitis B e antigen(HBeAg)-positive(4 had cirrhosis),and 8 were HBeAg negative at presentation.Of the 91 HBeAg-positive children,89 underwent HBeAg seroconversion after a mean period of 5.2 ±4.0 years and were included in the study.Of the 85 children without cirrhosis,one had HBeAg-negative hepatitis and the other 84 became inactive carriers.During a mean follow-up of 14.5 ±6.1 years after HBeAg seroclearance,4 carriers experienced reactivation,and 3 of them had HBeAg-negative hepatitis at the last follow-up.Of the 8 initially HBeAg-negative children,2 had HBeAg-negative hepatitis,and 6 were inactive carriers.Of the 4 children with cirrhosis,2 had hepatocellular carcinoma(HCC)and remained alive and 2 lost the histological features of cirrhosis in adulthood.Two patients with HBeAg-negative hepatitis and 1 with cirrhosis had experienced drug abuse.At the end of follow-up,15 of the 89 initially HBeAg-positive patients and 2 of 8 initially HBeAg-negative children had cleared hepatitis B surface antigen.In conclusion,the overall prognosis for chronic hepatitis B in horizontally infected Caucasian children is favorable;however,some patients progress to HCC and HBeAg-negative hepatitis.Long-term monitoring is important,as is counseling on cofactors of liver damage,such as alcohol and drug abuse.
Chronic hepatitis B is usually a benign disease in Caucasian children; however, the long-term prognosis remains unsettled. This report describes the results of a 29-year longitudinal study including 99 white children with chronic hepatitis B, mainly acquired hepatitis: 91 were hepatitis B e antigen (HBeAg) -positive (4 had cirrhosis), and 8 were HBeAg negative at presentation. Of the 91 HBeAg-positive children, 89 underwent HBeAg seroconversion after a mean period of 5.2 ± 4.0 years and were included in the study. Of the 85 children without cirrhosis, one had HBeAg-negative hepatitis and the other 84 became inactive carriers. After a mean follow-up of 14.5 ± 6.1 years after HBeAg seroclearance, 4 carriers experienced reactivation, and 3 of them had HBeAg-negative hepatitis at the last follow-up. Of the 8 initially HBeAg-negative children, 2 had HBeAg-negative hepatitis, and 6 were inactive carriers. Of the 4 children with cirrhosis, 2 had hepatocellular carcinoma (HCC) and alive and 2 lost the h istological features of cirrhosis in adulthood. two patients with HBeAg-negative hepatitis and 1 with cirrhosis had experienced drug abuse. At the end of follow-up, 15 of the 89 initially HBeAg-positive patients and 2 of 8 initially HBeAg-negative children had cleared hepatitis B surface antigen.In conclusion, the overall prognosis for chronic hepatitis B in shifting infected Caucasian children is favorable; however, some patients progress to HCC and HBeAg-negative hepatitis. Long-term monitoring is important, as is counseling on cofactors of liver damage, such as alcohol and drug abuse.