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Chronic Hepatitis B Natural History — RACP Paediatrics MCQ

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HardInfectious DiseaseChronic Hepatitis B Natural HistoryRACP Paediatrics

A 12-year-old has just been diagnosed with hepatitis B (HBsAg positive, HBeAg positive, high viral load). He acquired it perinatally. What is the natural history of perinatally acquired chronic hepatitis B?

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Correct answer: E — Immune-tolerant phase in childhood with high viral load but minimal liver inflammation; risk of complications in adulthood

Perinatally acquired chronic HBV: prolonged immune-tolerant phase (high viral load, normal ALT, minimal fibrosis) during childhood. Seroconversion and disease activity typically begin in adolescence/adulthood. Antiviral therapy is generally not indicated during the immune-tolerant phase. Monitoring with 6-monthly ALT and HBV DNA is recommended.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Chronic Hepatitis B