Updates in the management of hepatitis B in children
Journal
Expert Review of Gastroenterology and Hepatology
Journal Volume
13
Journal Issue
11
Pages
1065-1076
Date Issued
2019
Author(s)
Lai M.-W.
Abstract
Introduction: Universal infant hepatitis B virus (HBV) vaccination program has reduced HBV infection dramatically in vaccinated young generations. Management of chronically infected children is still challenging concerning high viral load with mostly mild diseases, yet with a nonnegligible proportion of advanced diseases, and long-term effect of antivirals. However, with more potent antivirals approved for pediatric patients, to start antivirals earlier in eligible patients may benefit their outcomes. This review aimed to update the current management of chronic hepatitis B in children. Areas covered: This review covered the natural history of chronic HBV infection, management of chronic hepatitis B in children from the past to the present, current consensus on the treatment of chronic hepatitis B in children, controversies in cessation of oral antivirals, and management of special populations such as pregnancy and co-infections. Expert opinions: Without contraindication, peginterferon is recommended for immune-active children ? 3?years old. For those intolerant, decompensating or preferring oral therapy, first-line Nucleos(t)ide analogs (NUC), Entecavir or Tenofovir, may be applied. For immune-tolerant or inactive carriers, close monitoring is crucial. When to stop NUCs and novel therapies for HBV cure await further research. ? 2019, ? 2019 Informa UK Limited, trading as Taylor & Francis Group.
Subjects
HBeAg seroconversion; HBeAg-negative hepatitis; HBsAg loss; immune clearance; immune tolerant; liver fibrosis; Nucleos(t)ide analogs; pegylated interferon; reactivation
SDGs
Other Subjects
antivirus agent; entecavir; hepatitis B surface antigen; hepatitis B(e) antigen; nucleoside derivative; nucleotide derivative; peginterferon; peginterferon alpha2a; recombinant alpha interferon; tenofovir; antivirus agent; hepatitis B vaccine; alopecia; antiviral therapy; behavior disorder; child; child health care; chronic hepatitis B; consensus development; cytopenia; delta agent hepatitis; diarrhea; disease course; drug approval; drug efficacy; drug indication; drug safety; drug withdrawal; flu like syndrome; genetic polymorphism; hepatitis C; high risk patient; human; Human immunodeficiency virus infection; immunocompromised patient; immunological tolerance; liver cell carcinoma; liver cirrhosis; mixed infection; nausea; patient monitoring; pregnancy; Review; risk benefit analysis; risk reduction; seroconversion; treatment duration; vomiting; adolescent; chronic hepatitis B; combination drug therapy; drug effect; female; genetics; Hepatitis B virus; infant; male; newborn; onset age; preschool child; prevalence; risk factor; sustained virologic response; treatment outcome; virology; virus load; Adolescent; Age of Onset; Antiviral Agents; Child; Child, Preschool; Drug Therapy, Combination; Female; Hepatitis B Vaccines; Hepatitis B virus; Hepatitis B, Chronic; Humans; Infant; Infant, Newborn; Male; Prevalence; Risk Factors; Sustained Virologic Response; Treatment Outcome; Viral Load
Publisher
Taylor and Francis Ltd
Type
review