Gastroenterology

Gastroenterology

Volume 127, Issue 6, December 2004, Pages 1733-1738
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Clinical relevance of hepatitis B virus genotype in children with chronic infection and hepatocellular carcinoma

https://doi.org/10.1053/j.gastro.2004.09.048Get rights and content

Background & Aims: The aim of this study was to investigate the influence of hepatitis B virus (HBV) genotypes on the clinical outcome of chronic childhood HBV infection and hepatocellular carcinoma (HCC). Methods: A total of 460 HBV carrier children were followed-up for 15 years and 26 children with HBV-related HCC were recruited. HBV genotyping was examined at enrollment and the latest follow-up of these carrier children and at diagnosis in HCC children. Viral load was checked at enrollment for the carrier children. These carriers were grouped based on their initial hepatitis B e antigen (HBeAg) and antibody to hepatitis B e antigen (anti-HBe) status. The HBeAg positive (+) group was divided further into an HBeAg(+/+) group and HBeAg(+/−) group, depending on whether spontaneous HBeAg seroconversion occurred during the follow-up period. Results: Genotype B constituted 73%, 86%, and 76% in the HBeAg(+/+), HBeAg(+/−), and anti-HBe(+) groups, respectively. Genotype C was found in 27%, 8%, and 6% in the HBeAg(+/+), HBeAg(+/−), and anti-HBe(+) group, respectively. Genotype C carriers were more prevalent in the HBeAg(+/+) group than the other 2 groups (P = .01), and had a delayed HBeAg seroconversion compared with the genotype B carriers (P < .001). Changes of genotype during the follow-up period were rare (2.8%). In those with HCC, genotype B was also the major type (74%). There was no difference in the baseline viral load between genotypes B and C. Conclusions: Although HBV genotype B dominates in children with chronic HBV infection and HCC in Taiwan, genotype C delays HBeAg seroconversion in pediatric chronic HBV infection.

Section snippets

Materials and methods

Under parental written consent, 460 HBsAg carrier children were followed-up consecutively every 6 months. These carrier children were enrolled from (1) the outpatient clinic of the National Taiwan University Hospital in a prospective study beginning approximately 23 years ago,18 (2) a prospective screening program for carrier children of HBsAg-seropositive mothers, and (3) 4 cross-sectional studies regarding a hepatitis B vaccination efficacy survey in 1984, 1989, 1994, and 1999.19 Each child

Basic and biochemical data

The baseline and peak ALT levels of the 3 groups of chronic HBV-infected children and the HCC group are shown in Table 1. Their ages at enrollment and at diagnosis were statistically different, the children in the HCC group were older than those in the HBV-infected groups (Mann–Whitney rank test, P < .001). At the latest follow-up evaluation, the ages of the 3 HBV carrier groups were approximately the same (P > .5).

Genotype distribution

Genotype B is the predominant strain of HBV in these children, but the

Discussion

This childhood study supplements the lack of data regarding HBV genotype during the natural history of chronic HBV infection in the first 2 decades of life. Our results confirmed previous observations in adults that HBV genotype B is most common in Taiwan.25 In the meantime, we confirmed that genotype C rather than genotype B delays HBeAg seroconversion in carrier children by 2 approaches: first, genotype C constituted a larger proportion in the HBeAg(+/+) than the other groups; and second,

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    Supported by grants from the National Science Council, Executive Yuan, Taiwan (NSC-90-2314-B-002-154 and NSC-91-2314-B-002-149).

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