All Title Author
Keywords Abstract


Growth Abnormalities in Children with Chronic Hepatitis B or C

DOI: 10.1155/2012/670316

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background. It has been suggested that chronic hepatitis B infection leads to growth impairment, but data are inconsistent and underlying factors are not defined. Methods. Children and adolescents with chronic hepatitis B (HBV) or C (HCV) were retrospectively evaluated for growth, weight, antiviral treatment, biochemical signs of liver inflammation, route of infection, and HBV DNA, respectively. Results. In all, 135 children (mean age 6.1 years, 81 male, 54 female) with HBV ( ) or HCV ( ) were studied. Route of infection was vertical in 50%, parenteral in 11%, and unknown in 39%. ALT levels were above 1.5 times above normal in 30% while 70% had normal/near normal transaminases. 80% were Caucasian, 14% Asian, 1% black, and 4% unknown. Mean baseline height measured in SDS was significantly lower in the study population than in noninfected children (boys ?1.2, girls ?0.4, ). 28 children were below 2 standard deviations of the norm while 5 were above 2 standard deviations. SDS measures in relation to individual factors were as follows: elevated ALT: boys ?1.4, females ?0.5 ( ), ALT normal/near normal: boys +0.4, females +0.6; parenteral transmission: boys ?3.3, girls ?0.9 ( ), vertical transmission: boys ?0.2, females ?0.2. Antiviral treatment itself or HBV-DNA load did not reach statistically significant differences. Conclusions. Chronic HBV or HCV may lead to compromised growth which is mostly influenced by liver inflammation. Our data may argue for early antiviral treatment in children with significant ALT elevation. 1. Introduction It is estimated that more than half of the world’s population has been infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), and 400–550 million people are chronic carriers. Since both are not cholestatic liver diseases, neither chronic hepatitis B (CHB) nor chronic hepatitis C (CHC) have been associated with those liver disorders most likely to affect the nutritional status and growth of children. A number of potential causes of malnutrition in chronic liver diseases have been identified [1], but previous studies have suggested that children with chronic hepatitis B or C seem to be smaller than children without infection [2, 3]. However, relatively few studies with limited numbers of patients have evaluated the impact of CHB on children’s growth [2–5]. Moreover, to our knowledge there is no study investigating growth of children with chronic hepatitis C. Furthermore, there is little knowledge about the influence of the specific virological status such as high or low viral load and elevated or normal

References

[1]  M. A. Novy and K. B. Schwarz, “Nutritional considerations and management of the child with liver disease,” Nutrition, vol. 13, no. 3, pp. 177–184, 1997.
[2]  R. J. Sokol and C. Stall, “Anthropometric evaluation of children with chronic liver disease,” American Journal of Clinical Nutrition, vol. 52, no. 2, pp. 203–208, 1990.
[3]  L. Comanor, J. Minor, H. S. Conjeevaram et al., “Impact of chronic hepatitis B and interferon-alpha therapy on growth of children,” Journal of Viral Hepatitis, vol. 8, no. 2, pp. 139–147, 2001.
[4]  A. Vegnente, S. Guida, and C. Di Costanzo, “Nutritional status and growth in children with chronic hepatitis B,” Journal of Pediatric Gastroenterology and Nutrition, vol. 14, no. 2, pp. 123–127, 1992.
[5]  C. Polito, A. La Manna, and M. L. Cartiglia, “Normal growth of children with HBsAg positive chronic active hepatitis (CAH),” Acta Paediatrica Scandinavica, vol. 80, no. 12, pp. 1231–1232, 1991.
[6]  J. Reinken and G. van Oost, “Longitudinale K?rperentwicklung gesunder Kinder von 0–18 Jahren,” Klinische Padiatrie, vol. 204, no. 3, pp. 129–133, 1992.
[7]  Z. Kulo?lu, A. Kansu, F. Demir?eken et al., “The influence of interferon-α and combination interferon-α and lamivudine therapy on height and weight in children with chronic hepatitis B infection,” Journal of Pediatric Endocrinology and Metabolism, vol. 20, no. 5, pp. 615–620, 2007.
[8]  M. Guido and F. Bortolotti, “Chronic viral hepatitis in children: any role for the pathologist?” Gut, vol. 57, no. 7, pp. 873–877, 2008.
[9]  M. W. Hilgartner, S. M. Donfield, H. S. Lynn et al., “The effect of plasma human immunodeficiency virus RNA and CD4+ T lymphocytes on growth measurements of hemophilic boys and adolescents,” Pediatrics, vol. 107, no. 4, article E56, 2001.
[10]  X. W. Zhang, F. Li, X. W. Yu, X. W. Shi, J. Shi, and J. P. Zhang, “Physical and intellectual development in children with asymptomatic congenital cytomegalovirus infection: a longitudinal cohort study in Qinba mountain area, China,” Journal of Clinical Virology, vol. 40, no. 3, pp. 180–185, 2007.

Full-Text

comments powered by Disqus