title: Management of chronic hepatitis B in children: an unresolved issue.
abstract: Although a rather benign course of chronic hepatitis B virus (HBV) infection during childhood has been described, 3-5% and 0.01-0.03% of chronic carriers develop cirrhosis or hepatocellular carcinoma before adulthood. Considering the whole lifetime, the risk of hepatocellular carcinoma rises to 9-24% and the incidence of cirrhosis to 2-3% per year. The aim of this article is to review the current knowledge regarding the natural history and treatment of chronic hepatitis B in children and to focus on critical aspects and unresolved questions in the management of childhood HBV infection. A literature search was carried out on MEDLINE, EMBASE, and Web of Science for articles published in English in peer-reviewed journals from January 1980 to February 2013. The search terms used included "Hepatitis B virus infection," "children," "HBV," "interferon," "lamivudine," "adefovir," "entecavir," and "tenofovir." Articles resulting from these searches and relevant references cited in the articles retrieved were reviewed. The current goals of therapy are to suppress viral replication, reduce liver inflammation, and reverse liver fibrosis. Therapeutic options for children are currently limited, and the risk for viral resistance to current and future therapies is a particular concern. Based on the data available at this time, it is the consensus of the panel that it is not appropriate to treat children in the immune-tolerant phase or in the inactive carrier state. For children in the immune-active or reactivation phases, liver histology can help guide treatment decisions. Outside of clinical trials, interferon is the agent of choice in most cases; currently, available nucleoside analogs are secondary therapies.
authors.affiliation: HepatoMetabolic Diseases Unit, Children's Hospital Bambino Gesù, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Della Corte
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
authors.forename: Donatella
authors.initials: D
authors.lastname: Comparcola
authors.forename: Francesca
authors.initials: F
authors.lastname: Cainelli
authors.forename: Sandro
authors.initials: S
authors.lastname: Vento
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology; D002353:Carrier State; D002648:Child; D016206:Databases, Bibliographic; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D015994:Incidence; D007372:Interferons / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology; D009705:Nucleosides / Q000627:therapeutic use; D063065:Organophosphonates / Q000627:therapeutic use; D012306:Risk; D000068698:Tenofovir
chemical_list: D000998:Antiviral Agents; D009705:Nucleosides; D063065:Organophosphonates; D019259:Lamivudine; C413685:entecavir; D006147:Guanine; C053001:adefovir; D007372:Interferons; D000068698:Tenofovir; D000225:Adenine
keywords: HBV infection; antiviral therapy; children