We read with interest the special article by Shneider et al.1, which was published in November 2006, but related to a conference held in March 2006.
As regards hepatitis B, Shneider et al. state: “Unfortunately at present there are inadequate numbers of patients with sufficiently long follow-up to give an accurate assessment of the lifelong risk and/or predictors of serious morbidity and mortality in children with chronic hepatitis B”, and “it is nearly impossible to assess an accurate risk of development of HCC before the age of 20 years in children with HBV infection acquired early in life.” We believe that our 29-year longitudinal study of chronic hepatitis B in 99 otherwise healthy children, published in March 2006,2 and commented on in Hepatology Highlights of April 2006,3 can give some answers with regard to the prognosis of chronic hepatitis in children infected postnatally early in life. Pediatric HBV infection is often identified with the Chinese model of vertical transmission and tolerance to the virus. However, in many areas of the world, including Southern Europe before compulsive HBV vaccination and Eastern Europe, children are preferably infected postnatally and do not develop tolerance. In this latter model of infection, the outcome within the first 20 years of life is benign (inactive hepatitis B surface antigen carrier state) in the vast majority of cases, although 2 patients in our cohort developed HCC and are long-term survivors after surgery. It is certainly true that life-long risks remain undefined, and environmental factors can change the prognosis at any time, but 3 decades of follow-up have covered at least the gap between the natural history of hepatitis B in children and in young adults in our endemic area.