乙肝杂志回顾 2 - 专家：不要急于治疗HBV感染儿童

StephenW

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."

Source: www.ncbi.nlm.nih.gov/pubmed/24192644

专家：不要急于治疗HBV感染儿童
专家审阅治疗HBV感染儿童的利弊研究，发现几个原因急于治疗受感染的儿童，特别是抗病毒药物，根据发表在抗病毒治疗杂志十一月号的解说。

迄今为止，最常见的治疗儿童接受一直干扰素，它一直没有非常成功的。大多数孩子实现大三阳serocoversion （失去HBeAg和发展中的“e”抗体）对自己没有接受治疗。

医生们都不愿使用儿童抗病毒药物，因为一旦开始就很难阻止他们。儿童发展中的风险耐药性与长期使用和感染的危险回潮一次抗病毒治疗停止。

“......这仍是未知之较早（ HBeAg）阳性血清转换是否（药物引起的）可以改变疾病的自然史，考虑到三分之二的肝硬化相关的并发症和（肝癌）在亚洲乙肝患者发生HBeAg血清转换后， “他们写道。

他们得出结论：

    已经有一些研究，有足够长的随访期，甚至， “准确评估进展对严重肝病的风险在儿童慢性乙型肝炎”

    虽然（ HBeAg）阳性血清学转换（无论是自发或药物引起）会出现，以改善儿童的健康，也出现了肝癌的儿童，他们报告的血清阳转后还是一样。

    “有治疗慢性乙型肝炎的童年没有准确的标准：年龄接受治疗是没有定义，对HBV DNA和（ ALT ）患儿的截止值尚未建立治疗时表示， 。治疗剂的首选仍然是不明确的。 “

    最后，研究成乙肝管理儿童是有限的，鲜为人知的是孩子到不同的护理如何回应。

“到目前为止，它仍然是（联合国）明确哪些条件的孩子应及时治疗或没有， ”他们写道。 “因此，仔细了解HBV感染和考虑响应的可能性和潜在的不良反应和良好的自发性病毒清除的可能性的自然史，才考虑治疗受感染儿童的需要。 ”

资料来源： www.ncbi.nlm.nih.gov/pubmed/24192644