儿童病毒性乙型和丙型肝炎的当前和未来管理。

StephenW

Clin Res Hepatol Gastroenterol. 2020 Mar 12. pii: S2210-7401(20)30043-7. doi: 10.1016/j.clinre.2020.02.010. [Epub ahead of print]
Present and future management of viral hepatitis B and C in children.
Clemente MG1, Antonucci R2, Sotgiu G2, Dettori M2, Piana A2, Vajro P3.
Author information

1
    Pediatric Clinic, Clinical Epidemiology and Medical Statistics Unit, Hygiene and Preventive Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari (SS), Italy. Electronic address: [email protected].
2
    Pediatric Clinic, Clinical Epidemiology and Medical Statistics Unit, Hygiene and Preventive Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari (SS), Italy.
3
    Pediatrics - Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi (SA), Italy.

Abstract

Having a hepatitis B virus (HBV) or hepatitis C virus (HCV) infection places a child at higher risk for subsequent chronic hepatitis B (CHB) or chronic hepatitis C (CHC) infection. The risk of mother-to-child transmission is higher for HBV (20% to 90%) than for HCV (<5%). Perinatal HBV infection generally causes CHB infection while perinatal HCV infection has a certain rate of spontaneous viral clearance (around 20% to 30%). Of the two, only HBV infection can benefit from passive/active perinatal immunoprophylaxis. The risk of CHB in children with HBV horizontal transmission decreases with age, whereas HCV transmission among teenagers commonly results into a long-life infection and CHC infection. Children with CHB or CHC should be carefully assessed for the need for antiviral treatment. When treatment cannot be deferred, pediatric CHB infection has different first-line treatment options: standard interferon (for children aged≥1 year), pegylated interferon (for children aged≥3 years), and the oral nucleotide analogues entecavir (for children aged≥2 years) and tenofovir (for children aged≥12 years). The choice of treatment depends on the child's age, virus genotypes, previous treatment failure and presence of contraindications. Expected responsiveness rate is 25% of hepatitis B e-antigen clearance, with both standard interferon and nucleotide analogues. Direct antiviral agents are first-line treatment for CHC infection in children aged 3 years or older. Hepatitis C virus sustained virus response is as high as 97%. Therefore, if direct antiviral agents can be proven to be safe and well tolerated in very young children, HCV eradication could be planned after the first screening.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.
KEYWORDS:

Direct antiviral agents; Interferon; Nucleotide analogues; Pediatrics; Pegylated; Viral hepatitis

PMID:
    32173307
DOI:
    10.1016/j.clinre.2020.02.010

StephenW

Clin Res Hepatol胃肠酸。 2020年3月12日。pii：S2210-7401（20）30043-7。 doi：10.1016 / j.clinre.2020.02.010。 [Epub提前发行]
儿童病毒性乙型和丙型肝炎的当前和未来管理。
克莱门特MG1，Antonucci R2，Sotgiu G2，Dettori M2，Piana A2，Vajro P3。
作者信息

1个
    意大利萨萨里大学萨萨里分校医学，外科和实验科学系卫生与预防医学小儿诊所，临床流行病学和医学统计部门。电子地址：[email protected]。
2
    意大利萨萨里大学萨萨里分校医学，外科和实验科学系卫生与预防医学小儿诊所，临床流行病学和医学统计部门。
3
    儿科-意大利巴罗尼西（SA）萨勒诺大学医学，外科和牙科系“ Scuola Medica Salernitana”。

抽象

患有乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）感染会使儿童处于随后的慢性乙型肝炎（CHB）或慢性丙型肝炎（CHC）感染的较高风险中。 HBV（20％至90％）的母婴传播风险高于HCV（<5％）。围产期HBV感染通常会导致CHB感染，而围产期HCV感染具有一定的自发病毒清除率（大约20％至30％）。在这两者中，只有HBV感染可以受益于被动/主动围产期免疫预防。 HBV水平传播儿童的CHB风险会随着年龄的增长而降低，而青少年中HCV传播通常会导致长期感染和CHC感染。患有CHB或CHC的儿童应仔细评估是否需要抗病毒治疗。当不能推迟治疗时，小儿CHB感染有不同的一线治疗选择：标准干扰素（≥1岁的儿童），聚乙二醇化干扰素（≥3岁的儿童）和口服核苷酸类似物恩替卡韦（≥2岁的儿童） 2岁）和替诺福韦（适用于12岁以上的儿童）。治疗的选择取决于孩子的年龄，病毒基因型，先前的治疗失败和禁忌症的存在。使用标准干扰素和核苷酸类似物，预期的响应率为乙型肝炎电子抗原清除率的25％。直接抗病毒药物是3岁以上儿童CHC感染的一线治疗。丙型肝炎病毒持续的病毒应答率高达97％。因此，如果可以证明直接的抗病毒药物在很小的儿童中是安全的并且耐受性良好，那么可以在首次筛查后计划消灭HCV。

版权所有©2020 Elsevier Masson SAS。版权所有。
关键字：

直接抗病毒药；干扰素核苷酸类似物；儿科;聚乙二醇化;病毒性肝炎

PMID：
    32173307
DOI：
    10.1016 / j.clinre.2020.02.010