Treatment of chronic hepatitis B in children: an article summarizing treatment drugs and treatment indications

Introduction Hepatitis B virus (HBV) infection is one of the leading causes of morbidity and mortality worldwide
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Most children become infected in the perinatal or early childhood and develop chronic hepatitis
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The primary goal of antiviral therapy in children with chronic HBV infection (CHB) is to inhibit viral replication and prevent disease progression to cirrhosis and hepatocellular carcinoma
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This article summarizes the drugs currently available for the treatment of CHB in children and adolescents, and the indications for treatment in children and adolescents
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Treatment of CHB in Children and Adolescents: List of Approved Drugs Table 1 shows the antiviral drugs currently approved for the treatment of CHB in children and adolescents, their age of administration, drug dosage, and mode of administration
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Table 1 Antiviral drugs approved for the treatment of CHB in children and adolescents Overall, interferon-based therapy was associated with higher rates of hepatitis B e antigen (HBeAg) and hepatitis B surface antigen (HBsAg) seroconversion, It can be used for short-term treatment, but the tolerance is poor and there are many adverse reactions
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Nucleoside (acid) analogs are usually used for long-term oral therapy with good overall safety
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Indications for Treatment of CHB in Children and Adolescents In children and adolescents with CHB, the decision to initiate treatment is made by assessing the patient's liver disease stage, HBV DNA and alanine aminotransferase (ALT) levels, and HBeAg status
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Features such as a family history of hepatocellular carcinoma, co-infection with human immunodeficiency virus, or other concomitant liver disease are also factors that influence the decision to initiate therapy
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Regardless of age, all guidelines recommend children with cirrhosis, necroinflammation and fibrosis (active hepatitis), fulminant or severe acute hepatitis B infection, and those receiving immunosuppression or chemotherapy with evidence of previous or persistent HBV infection Children receive treatment
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For children with CHB who do not meet the above treatment criteria, there are some differences between the treatment recommendations given in the existing guidelines, as shown in Table 2
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Table 2 Recommendations for the treatment of CHB in children and adolescents by various societies Note: ESPGHAN: European Society for Pediatric Gastroenterology and Hepatology and Nutrition; AASLD: American Association for the Study of Liver Diseases; APASL: Asia Pacific Association for the Study of the Liver; EASL: European Association for the Study of the Liver; ULN: Upper limit of normal References: [1] Stinco M, Rubino C, Trapani S, et al.
Treatment of hepatitis B virus infection in children and adolescents[J].
World J Gastroenterol.
Sep 28, 2021; 27(36) : 6053-6063.
doi: 10.
3748/wjg.
v27.
i36.
6053[2] Zhu Peng, Tang Yi, Wang Yuming.
Recommendations of "Clinical Practice Guidelines for Hepatitis B Management of the Asia-Pacific Society of Liver Diseases (updated in 2015)"[J] .
Journal of Clinical Hepatobiliary Diseases, 2016, 32(3):423-428.
Submission email: tougao@medlive.
cn