Management of chronic hepatitis B in children: an unresolved issue
Claudia Della Corte MD1,*,
Valerio Nobili MD1,
Donatella Comparcola MD1,
Francesca Cainelli MD2,
Sandro Vento MD2
DOI: 10.1111/jgh.12550
This article is protected by copyright. All rights reserved.
Issue
Vol. 29 Issue 3
Journal of Gastroenterology and Hepatology
Accepted Article (Accepted, unedited articles published online and citable.
The final edited and typeset version of record will appear in future.)
Abstract
Although a rather benign course of chronic Hepatitis B (HBV) virus
infection during childhood has been described, 3–5% and 0.01–0.03% of
chronic carriers develop cirrhosis or hepatocellular carcinoma (HCC) before
adulthood. Considering the whole lifetime, the risk of HCC 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”,
“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, IFN is the agent of choice in most cases; currently
available nucleoside analogues are secondary therapies. 作者: StephenW 时间: 2014-2-27 12:08