Management of chronic hepatitis B in children: An unresolved issue

Claudia Della Corte, Valerio Nobili, Donatella Comparcola, Francesca Cainelli, Sandro Vento

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

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 Web of Science for articles published in English in peer-reviewed journals from January 1980 to February 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.

Original languageEnglish
Pages (from-to)912-919
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume29
Issue number5
DOIs
Publication statusPublished - May 2014

Keywords

  • Antiviral therapy
  • Children
  • HBV infection

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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