title: Treatment of children with chronic hepatitis B virus infection in the United States: patient selection and therapeutic options.
abstract: Chronic hepatitis B virus (HBV) infection in children presents a therapeutic challenge for the practitioner. Decisions regarding selection of patients who may benefit from treatment, appropriate timing of treatment, and the choice of antiviral therapy are complex and are compounded by the limited number of drugs that have been studied in children. An expert panel of nationally recognized pediatric liver specialists was convened by the Hepatitis B Foundation on August 11, 2009, to consider clinical practice relative to the therapeutic options available for children. A detailed account of these discussions is provided, and the opinions expressed are based on consensus of the experts, as well as on published evidence when available. The panel concludes that, at this time, there is no established benefit of treatment of children in the immune tolerant phase, and there is a very high risk of development of drug resistance. In addition, there is no indication for treatment of children in the inactive carrier state. For children in the immune active or reactivation phases, liver histology can help guide treatment decisions, and family history of liver disease, especially hepatocellular carcinoma, may argue for early treatment in some cases. Outside of clinical trials, interferon is the agent of choice in most cases. Nucleos(t)ide analogues are secondary therapies, and children who receive these agents require careful monitoring for development of resistance. There are a few situations when treatment is indicated regardless of HBV DNA or alanine aminotransferase levels. There is still much to be elucidated about the appropriate use of HBV therapy in children. Until more clinical data and therapeutic options are available, a conservative approach is warranted.
authors.affiliation: Division of Gastroenterology, Children's Hospital Boston, Boston, MA 02115, USA. maureen.jonas@childrens.harvard.edu
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Jonas
authors.forename: Joan M
authors.initials: JM
authors.lastname: Block
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Haber
authors.forename: Saul J
authors.initials: SJ
authors.lastname: Karpen
authors.forename: W Thomas
authors.initials: WT
authors.lastname: London
authors.forename: Karen F
authors.initials: KF
authors.lastname: Murray
authors.forename: Michael R
authors.initials: MR
authors.lastname: Narkewicz
authors.forename: Philip
authors.initials: P
authors.lastname: Rosenthal
authors.forename: Kathleen B
authors.initials: KB
authors.lastname: Schwarz
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McMahon
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D024882:Drug Resistance, Viral; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D063065:Organophosphonates / Q000627:therapeutic use; D018579:Patient Selection; D011994:Recombinant Proteins
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D063065:Organophosphonates; D011994:Recombinant Proteins; D019259:Lamivudine; D000410:Alanine Transaminase; D000225:Adenine; C106812:adefovir dipivoxil