P0298 HEPATITIS B IN CHILDREN MOVING FROM OTHER COUNTRIES

Abstract

Introduction: AIMS: Description of natural course of children with chronic hepatitis B acquired outside the country. Methods: Between 1997–2003, 50 children were diagnosed at arrival from other countries of Africa (32%), Europe (30%), Asia (26%) or America (12%). Median age was 5 years, 64% were adopted. Data of diagnosis and follow-up (median 19 months) were reviewed. Results: At diagnosis none presented liver failure or HCC, 66% had abnormal ALT, 20% were antiHBe+, 80% HBeAg+, 80% showed HBV-DNA+ by DIGENE® (median 2621 pg/ml).HDV affected 2%. Follow-up: a) antiHBe+ patients: all normalized or maintained normal ALT, HBV-DNA was undetectable. b) HBeAg+ patients: During HBeAg+ phase no correlation was found between ALT and HBV-DNA (98 samples). In 21 cases biopsy was performed, Knodell ranged 0–12, median 4. A significant correlation was found between ALT and total HAI (p<0.01, r2:0.64), periportal hepatitis and fibrosis scores. HAI and HBV-DNA did not correlate. Different patterns of ALT and HBV-DNA were observed in HBeAg+ phase. ALT was N=sustained normal in 6, SMA=sustained mild abnormal <100 U/L in 10, SSA=sustained significant abnormal >100 U/L in 15, and CH=changing values in 9. HBV-DNA was sustained in low values mean:970±481 pg/ml in 13, in high values mean: 4684±1248 pg/ml in 19, and showed changing values in 8. Seroconversion probability was 11.3% and 28.9% by 1 and 2 years. Seroconverters showed a previous mean ALT higher to those persisting HBeAg+ (250±148 vs 100±86 U/L, p<0.01) but no differences in previous mean HBV-DNA values (2289±2353 vs 3383±1899 pg/ml). One-year seroconversion probability was 23% in SSA vs 0% in N, SMA or CH, and (according to HBV-DNA pattern) 16.6% in low vs 7.1% in high and 0% in changing values. Conclusion: Chronic hepatitis B infection had no overt differences according to geographic origin. During HBeAg+ phase ALT and HBV-DNA values do not correlate, ALT values are more useful than HBV-DNA values to predict liver damage and sero-conversion.