Experts: Do Not Rush to Treat HBV-Infected Children
Experts reviewed studies on the pros and cons of treating children infected with HBV and found few reasons to rush to treat infected children, especially with antivirals, according to their commentary published in the November issue of the Journal of Antiviral Therapy.
To date, the most common treatment children have received has been interferon, which has not been highly successful. Most children achieve HBeAg serocoversion (losing HBeAg and developing "e" antibodies) on their own without treatment.
Doctors are hesitant to use antivirals in children, because once started it is difficult to stop them. Children risk developing drug resistance with long-term use and a dangerous resurgence of infection once antiviral treatment stops.
"... It is still unknown whether (drug-induced) earlier (HBeAg) seroconversion can modify the natural history of the disease, considering that two-thirds of cirrhosis-related complications and (liver cancers) in Asian patients with hepatitis B occur after HBeAg seroconversion," they wrote.
They concluded:
There have been few studies with a sufficiently long follow-up period to even, "accurately assess the risk of progression towards serious liver disease in children with chronic hepatitis B."
Although (HBeAg) seroconversion (either spontaneous or drug-induced) appears to improve children's health, there have been reports of liver cancer in children even after they seroconverted.
"There is no accurate standard for treatment of chronic hepatitis B in childhood: the age to undergo treatment is not defined; the cut-off value for HBV DNA and for (ALT) in children has not yet been established. When therapy is indicated, the preferred choice of therapeutic agent is still not clear."
Finally, studies into hepatitis B management in children are limited and little is known how children respond to the different available treatments.
"To date, it remains (un)clear in which conditions children should be treated or not," they wrote. "Thus, careful understanding of the natural history of HBV infection and consideration of likelihood of response and potential adverse events and the possibility of favorable spontaneous viral clearance is needed before considering treatment of infected children."