Epidemiology

Hepatitis B associated with childhood hepatocellular carcinoma in Taiwan

Last Updated: 2004-04-02 12:17:41 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Chronic hepatitis B virus (HBV) infection is closely associated with the development of hepatocellular carcinoma (HCC) in Taiwanese children, according to a report in the March issue of the Journal of Pediatrics.

HCC typically develops after decades of HBV infection, the authors explain, but the incidence of childhood HCC in Taiwan, where HBV infection was hyperendemic, seemed unusually high.

Dr. Mei-Hwei Chang from National Taiwan University Hospital, Taipei, and colleagues studied the incidence of HCC among 426 children with chronic HBV infection followed a median 14.9 years after study entry.

Two of the children (both boys) were diagnosed with cirrhosis and HCC, the authors report, for an HCC incidence of 32 cases per 100,000 person-years. This compares with an annual incidence of less than 0.06 per 100,000 children younger than 15 years old in the United States.

One additional boy had cirrhosis, the report indicates, and all three of these boys developed anti-HBe (indicating active replication of HBV) during the study.

The rate of HCC was significantly higher in children who became anti-HBe before the age of 3 years and in children who had cirrhosis, the investigators report.

The relative risk of HCC for HBsAg carrier children compared with uninfected children is "difficult to assess because nearly all Taiwanese children with HCC are HBsAg-positive," the researchers note.

"The biologic behavior of childhood HCC is similar to that of adult HCC," Dr. Chang told Reuters Health. "But HCC in children is usually diagnosed late, because no routine screening program is offered for HBsAg carrier children."

Therefore their outcome is worse than that for adults. "Most of them respond poorly to chemotherapy and die within 6 months after diagnosis," the researcher said.

"Hepatitis B carrier children should be screened for liver cancer," Dr. Chang recommended, "with alpha-fetoprotein and imaging, particularly those born to HBsAg carrier mothers."

"Taiwan launched the world's first universal hepatitis B vaccination program in July 1984," Dr. Chang added. "The hepatitis B surface antigen positive rate has declined from around 10% before the vaccination program to less than 1% (0.8% on average) in those born after the launch of the vaccination program."

J Pediatr 2004;144:397-399.