Natural history and clinical management of chronic hepatitis B virus infection in children
Journal
Hepatology International
Journal Volume
2
Journal Issue
SUPPL. 1
Pages
S28-S36
Date Issued
2008
Author(s)
Abstract
Hepatitis B virus (HBV) infection may cause acute, fulminant, or chronic hepatitis, leading to liver cirrhosis or hepatocellular carcinoma. Despite the availability of effective vaccine, HBV infection during infancy or early childhood is common in areas of high endemicity. In these regions, mother-to-infant transmission accounts for approximately 50% of chronic infections. Although the natural history of HBV infection in adults is well characterized, little information is available in the literature regarding the natural history of HBV infection in children. Similar to infection in adults, chronic HBV infection in children can be divided into distinct phases: immune tolerant, immune clearance, and inactive carrier state. However, acute exacerbation, with reactivation of HBV replication and re-elevation of alanine aminotransferase levels after hepatitis B e antigen seroconversion, is relatively rare in children, in comparison to adults. Although several potent antiviral agents are now available for the treatment of chronic hepatitis B, experience with these agents in the pediatric setting is limited. To date, conventional interferon α and lamivudine are the only two antiviral agents approved to treat chronic hepatitis B in children. The rapid emergence of resistant HBV associated with long-term lamivudine therapy, as well as poor tolerability associated with conventional interferon α, are factors that should be considered before initiating antiviral therapy. This article reviews current knowledge regarding the natural history and treatment of chronic hepatitis B in children. Factors that affect the natural history of HBV infection in children are also reviewed. ? Asian Pacific Association for the Study of the Liver 2008.
Subjects
Adolescents; Children; Chronic hepatitis B; Hepatitis B e antigen; Hepatitis B virus
SDGs
Other Subjects
adefovir; alanine aminotransferase; alpha interferon; alpha2a interferon; antivirus agent; entecavir; hepatitis B surface antigen; hepatitis B(e) antigen; lamivudine; peginterferon alpha; placebo; telbivudine; bone marrow suppression; child; child care; clinical trial; combination chemotherapy; depression; disease course; drug absorption; drug bioavailability; drug indication; fever; flu like syndrome; gene mutation; genotype; hair loss; hepatitis B; Hepatitis B virus; histopathology; human; immunological tolerance; injection pain; injection site pain; leukopenia; liver cell carcinoma; liver fibrosis; malaise; monotherapy; mutant; nephrotoxicity; nonhuman; perinatal infection; prevalence; priority journal; promoter region; review; risk factor; seroconversion; stop codon; treatment duration; unspecified side effect; virus gene; virus replication; virus transmission
Type
review