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Updates in the management of hepatitis B in children

Ming-Wei Lai1,2,3, Mei-Hwei Chang4

  • 1Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan.

Expert Review of Gastroenterology & Hepatology
|October 31, 2019
PubMed

Insights

Universal infant hepatitis B vaccination significantly reduces HBV infection. Early antiviral treatment in children with chronic hepatitis B may improve outcomes, with specific recommendations for peginterferon and nucleos(t)ide analogs.

Area of Science:

  • Pediatric Hepatology
  • Virology
  • Immunology

Background:

  • Universal infant hepatitis B virus (HBV) vaccination has dramatically reduced new infections.
  • Chronic HBV infection in children presents challenges due to high viral loads and potential for advanced disease.
  • Emerging potent antivirals offer new treatment possibilities for pediatric patients.

Purpose of the Study:

  • To provide an updated review on the management of chronic hepatitis B in children.
  • To discuss the natural history, current treatment consensus, and special considerations for pediatric HBV.
  • To highlight expert opinions on treatment strategies and future research directions.

Main Methods:

  • Comprehensive literature review of chronic hepatitis B management in children.
  • Analysis of current consensus guidelines and expert opinions.
  • Inclusion of data on natural history, treatment options, and special populations.

Main Results:

  • Peginterferon is recommended for immune-active children aged 3 years and older without contraindications.
  • First-line oral Nucleos(t)ide analogs (NUCs) like Entecavir or Tenofovir are options for specific pediatric groups.
  • Close monitoring is essential for immune-tolerant or inactive HBV carriers.

Conclusions:

  • Early initiation of effective antiviral therapy in eligible children with chronic hepatitis B is encouraged.
  • Treatment decisions should consider patient's immune status, disease activity, and tolerance.
  • Further research is needed on NUC cessation and novel therapies for a potential HBV cure.

Keywords:
HBeAg seroconversionHBeAg-negative hepatitisHBsAg lossNucleos(t)ide analogsimmune clearanceimmune tolerantliver fibrosispegylated interferonreactivation

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