Clinical and histological outcome after hepatitis B e antigen to antibody seroconversion in children with chronic hepatitis B

Data regarding the outcome of children with chronic hepatitis B after seroc onversion are scarce. We describe the long-term evolution of these patients . One hundred and three children with antibody against hepatitis B e antige n and normal alanine aminotransferase (ALT) levels were followed for 0.6 to 12.5 years (mean, 6.3 years). Paired liver biopsies (before and after sero conversion) were available in 83 cases. Final biopsies were obtained 0.5 to 12.5 years (mean, 4.5 years) after seroconversion, ALT levels remained nor mal in most of the children (79%) throughout the follow-up, All children, e xcept five who lost hepatitis B surface antigen, had serum viral DNA detect ed by polymerase chain reaction. When comparing baseline and final liver bi opsies, a significant improvement (P < .001) was found in the histological activity index and in the necrosis, cytolysis, inflammation, and fibrosis s cores. The histological diagosis improvement in the final biopsy was signif icantly related (P < .001) to the time from seroconversion to the biopsy pe rformance, All children had viral DNA on their final liver biopsy. In summa ry, seroconversion and ALT normalization are quite stable findings in child ren, and no differences in the long-term outcome between treated and untrea ted children were found. In light of the histological outcome, it seems unn ecessary to perform a follow-up liver biopsy in these cases.