Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Immune tolerance phase of HBV infection is the first phase and characterized by high serum HBV DNA levels, the positivity of HBeAg and normal or slightly elevated ALT levels. The patients are usually asymptomatic and highly infectious. Most children fall in the immune-tolerant phase. There are several noninvasive diagnostic methods for determining liver fibrosis. The aim of the current study is to assess the degree of fibrosis in immune tolerant HBV infected children. We assessed 44 children with chronic HBV infection by fibro elastogrophy and by calculating the APRI and FIB - 4 tests. Our results showed that history of infected mother was present in 100% of cases. Almost all cases were asymptomatic, 13.5% of cases were below 5th percentile for weight and height. Cases with HBeAg + ve had significant higher PCR count than HBeAg - ve cases. Fibrosis was detected by fibro elastography in 3 cases (6.8%) although these cases had normal liver biochemical profile and normal APRI and FIB-4 tests results. All APRI test and FIB-4 test results were normal. There was significant association between stiffness by fibroscan and APRI results. There is significant increase in Fib-4 test results during follow up. During follow up of cases, we observed that: A significant increase in ALT levels, AST levels and FIB-4 test results in HBeAg +ve cases and a significant decrease in ALT levels, AST levels and APRI test results in HBeAg - ve cases. In conclusion: History of infected mother was present in 100% of cases. Almost all cases of immune tolerant HBV infection were asymptomatic. Transient fibro elastography is a good predictor of presence of fibrosis

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