title: Antiviral therapy in management of chronic hepatitis B viral infection in children: A systematic review and meta-analysis.
abstract: Most individuals with chronic hepatitis B viral (HBV) infection acquired the infection around the time of birth or during early childhood. We aimed to synthesize evidence regarding the effectiveness of antiviral therapy in the management of chronic HBV infection in children. We conducted a comprehensive search of multiple databases from 1988 to December 2, 2014, for studies that enrolled children (<18 years) with chronic HBV infection treated with antiviral therapy. We included observational studies and randomized controlled trials (RCTs). Two independent reviewers selected studies and extracted data. In the 14 included studies, two cohort studies showed no significant reduction in the already low risk of hepatocellular carcinoma or cirrhosis and 12 RCTs reported intermediate outcomes. In RCTs with posttreatment follow-up <12 months, antiviral therapy compared to placebo improved alanine aminotransferase normalization (risk ratio [RR] = 2.3, 95% confidence interval [CI] 1.7-3.2), hepatitis B e antigen (HBeAg) clearance/loss (RR = 2.1, 95% CI 1.5-3.1), HBV DNA suppression (RR = 2.9, 95% CI 1.8-4.6), HBeAg seroconversion (RR = 2.1, 95% CI 1.4-3.3), and hepatitis B surface antigen clearance (RR = 5.8, 95% CI 1.1-31.5). In RCTs with posttreatment follow-up ≥12 months, antiviral therapy improved cumulative HBeAg clearance/loss (RR = 1.9, 95% CI 1.7-3.1), HBeAg seroconversion (RR = 2.1, 95% CI 1.3-3.5), alanine aminotransferase normalization (RR = 1.4, 95% CI 1.1-1.7), and HBV DNA suppression (RR = 1.4, 95% CI 1.1-1.8) but not hepatitis B surface antigen clearance or seroconversion.
  
  
  CONCLUSIONS
  In children with chronic HBV infection, antivirals compared to no antiviral therapy improve HBV DNA suppression and frequency of alanine aminotransferase normalization and HBeAg seroconversion.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Jonas
authors.affiliation: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.
authors.forename: Anna S F
authors.initials: AS
authors.lastname: Lok
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: McMahon
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Brown
authors.affiliation: Department of Medicine, Tufts Medical Center, Boston, MA.
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
authors.affiliation: Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.|Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Ahmed T
authors.initials: AT
authors.lastname: Ahmed
authors.affiliation: Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.|Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Wigdan
authors.initials: W
authors.lastname: Farah
authors.affiliation: Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Mouchli
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Library Public Services, Mayo Clinic, Rochester, MN.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.|Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.|Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.|Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.|Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Khaled
authors.initials: K
authors.lastname: Mohammed
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D000998:Antiviral Agents