Pediatric HBV-Related Cirrhosis Often Goes Unnoticed
Pediatric HBV-related cirrhosis often appears silent yet early antiviral therapy in children was tied to better long-term outcomes.
A single center observational study evaluated Pediatric HBV-Related Cirrhosis among children with chronic hepatitis B, a condition that can appear mild for years after infection. Investigators reviewed 1,332 pediatric patients with chronic HBV infection treated between January 2010 and January 2023 and identified 62 cases of liver cirrhosis confirmed by liver biopsy. Most patients were male (87.1%), and the median age was 11 years (range 4 to 14).
Clinical presentation was frequently subtle. At cirrhosis diagnosis, 77.4% of children were asymptomatic, compared with 11.6% of adults with HBV-related liver cirrhosis in the comparator cohort. Adults also reported more fatigue (27.5% versus 4.8%), abdominal discomfort (23.2% versus 9.7%), nausea (10.1% versus 0%), and poor appetite (8.7% versus 6.5%), with all symptom comparisons reported as statistically significant.
Virological and Pathological Features Differ by Age
To contextualize pediatric disease, the authors compared the pediatric cirrhosis cohort with 64 age and sex matched pediatric chronic hepatitis B cases and with 69 adults with HBV-related cirrhosis. Compared with pediatric chronic hepatitis B, Pediatric HBV-Related Cirrhosis was associated with lower quantitative HBV DNA (median log10 IU/mL 6.3 versus 17.4; P<0.001), lower HBsAg titers (median log10 IU/mL 3.11 versus 8.956; P<0.0001), and a lower hepatitis B e antigen positive rate (81.4% versus 93.8%; P<0.05).
In contrast, when children with cirrhosis were compared with adults with cirrhosis, the authors report higher virological parameters and higher transaminase levels in the pediatric group, suggesting a distinct disease biology even when clinical symptoms are limited.
Antiviral Therapy Was Linked to Better Long-Term Outcomes
Long term follow-up highlighted clinically meaningful differences after antiviral therapy. Functional cure occurred in 17.4% of children with cirrhosis and in 0% of adults. After treatment, adults had a higher incidence of cirrhosis progression than children (hazard ratio 6.102; 95% CI: 1.72 to 21.65; P=0.00051), while cirrhosis remission was more frequent in children than adults (hazard ratio 0.055; 95% CI: 0.07128 to 0.2802; P<0.0001).
Taken together, the findings suggest pediatric HBV-Related cirrhosis may be missed because of minimal symptoms, but outcomes can improve substantially when antiviral therapy is started early.
Reference: Zhao BK et al. Clinical, pathological characteristics and long-term outcomes of hepatitis B virus related cirrhosis in pediatric observational study. World J Gastroenterol. 2025;31(48):114049.
