Significant histologic alterations in untreated chronic hepatitis B children: a meta-analysis.

BACKGROUND: Chronic hepatitis B (CHB) in children poses a significant public health challenge, yet data on the prevalence of significant liver lesions in this group are limited. METHODS: A comprehensive meta-analysis pooled data on the proportion of significant liver lesions among CHB children. Using the double arcsine transformation and a random-effects model, we combined data on moderate to severe liver inflammation, fibrosis, and cirrhosis. Subgroup analysis and meta-regression were conducted to explore heterogeneity. RESULTS: Twenty-two studies with 3,037 participants were included. The proportion of moderate to severe inflammation was 41.54% [95% Confidence Interval (CI): 29.14-54.47%], notable fibrosis was 31.71% [95% CI: 23.85-40.11%], and cirrhosis was 2.27% [95% CI: 1.06-3.82%]. Inflammation varied significantly by age group: < 6 years, 36.21%; 6-12 years, 53.72%; 12-18 years, 31.40% (p < 0.01). ALT ≥ 80 U/L was associated with higher inflammation (57.78%) compared to ALT < 80 U/L (29.73%) (p < 0.01). Cirrhosis also varied significantly by age group. CONCLUSIONS: A substantial proportion of CHB children have significant liver lesions, underscoring the need for enhanced screening and monitoring.