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Management of chronic hepatitis B in children: An unresolved issue
Author(s) -
Della Corte Claudia,
Nobili Valerio,
Comparcola Donatella,
Cainelli Francesca,
Vento Sandro
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12550
Subject(s) - medicine , entecavir , hepatocellular carcinoma , lamivudine , cirrhosis , adefovir , hepatitis b virus , hepatitis b , immunology , intensive care medicine , virus
Although a rather benign course of chronic hepatitis B virus ( HBV ) infection during childhood has been described, 3–5% and 0.01–0.03% of chronic carriers develop cirrhosis or hepatocellular carcinoma before adulthood. Considering the whole lifetime, the risk of hepatocellular carcinoma rises to 9–24% and the incidence of cirrhosis to 2–3% per year. The aim of this article is to review the current knowledge regarding the natural history and treatment of chronic hepatitis B in children and to focus on critical aspects and unresolved questions in the management of childhood HBV infection. A literature search was carried out on MEDLINE , EMBASE , and W eb of S cience for articles published in E nglish in peer‐reviewed journals from J anuary 1980 to F ebruary 2013. The search terms used included “Hepatitis B virus infection,” “children,” “ HBV ,” “interferon,” “lamivudine,” “adefovir,” “entecavir,” and “tenofovir.” Articles resulting from these searches and relevant references cited in the articles retrieved were reviewed. The current goals of therapy are to suppress viral replication, reduce liver inflammation, and reverse liver fibrosis. Therapeutic options for children are currently limited, and the risk for viral resistance to current and future therapies is a particular concern. Based on the data available at this time, it is the consensus of the panel that it is not appropriate to treat children in the immune‐tolerant phase or in the inactive carrier state. For children in the immune‐active or reactivation phases, liver histology can help guide treatment decisions. Outside of clinical trials, interferon is the agent of choice in most cases; currently, available nucleoside analogs are secondary therapies.