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2017 ; 5
(3
): 37
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Pediatric hepatitis B treatment
#MMPMID28251116
Komatsu H
; Inui A
; Fujisawa T
Ann Transl Med
2017[Feb]; 5
(3
): 37
PMID28251116
show ga
Although the introduction of hepatitis B vaccine has been contributing to the
reduction in the prevalence of hepatitis B virus (HBV) carriers worldwide, the
treatment of children with chronic HBV infection is a challenge to be addressed.
HBeAg seroconversion, which induces low replication of HBV, is widely accepted as
the first goal of antiviral treatment in children with chronic hepatitis B.
However, spontaneous HBeAg seroconversion is highly expected in children with
chronic HBV infection. Therefore, the identification of children who need
antiviral treatment to induce HBeAg seroconversion is essential in the management
of chronic HBV infection. Guidelines and experts' opinion show how to identify
children who should be treated and how to treat them. If decompensated cirrhosis
is absent, interferon-alpha is the first-line antiviral treatment. Nucleos(t)ide
analogues (NAs), such as lamivudine, adefovir, entecavir and tenofovir, are also
available for the treatment of children, although the approval age differs among
them. If decompensated cirrhosis is present, NAs are the first-line antivirals.
When the emergence of drug-resistant HBV variants is taken into consideration,
entecavir (approved for age 2 years or older) and tenofovir (age 12 years or
older), which have high genetic barriers, will play a central role in the
treatment of HBV infection. However, the optimal duration of NA treatment and
adverse events of long-term NA treatment remain unclear in children. In
resource-constrained countries and regions, the financial burden of visiting
hospitals, receiving routine blood examination and purchasing antiviral drugs is
heavy. Moreover, there is no clear evidence that the induction of HBeAg
seroconversion by antiviral treatment prevents the progression of liver disease
to cirrhosis and hepatocellular carcinoma in children with chronic HBV infection.
It is thus imperative to clarify the clinical impact of antiviral treatment in
children with HBV infection.
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