Pharmacotherapy options for managing hepatitis B in children

ABSTRACT

Introduction

To eliminate viral hepatitis by 2030, the World Health Organization (WHO) launched the first global health sector strategy on viral hepatitis, with particular focus given to hepatitis B and C in 2016. To achieve the reduction of mortality in children, it is indispensable to know which children should be treated and how to treat them.

Area covered

In this article, the authors review the antiviral treatment of children with chronic hepatitis B virus (HBV) infection including antivirals available for children with chronic HBV infection.

Expert opinion

The approvals of nucleos(t)ide analogues (NAs) and pegylated interferon (PEG-IFN) for children have lowered a hurdle to the initiation of antiviral treatment in children. The international guidelines use nearly the same criteria of antiviral treatment for children with chronic HBV infection, but the WHO guidelines provide a cautious stance on the antiviral treatment of children. Not only PEG-IFN but also NAs with a high genetic barrier to drug resistance should be the first-line treatment for children. In settings with limited medical resources, NAs can be the first-line treatment for children. Although the concept of an ‘immune-tolerant phase’ is challenged, evidence is not sufficient to recommend the treatment of HBeAg-positive immune-tolerant children.

KEYWORDS:

• Hepatitis B virus
• children
• interferon
• nucleos(t)ide analogue
• cirrhosis
• hepatocellular carcinoma
• guideline
• histology
• biopsy

Article highlights

• Although there are small differences in the indications for antiviral treatment among international guidelines, children with HBeAg-positive/-negative chronic hepatitis (immune-active phase and reactivation phase) are eligible for antiviral treatment.

• PEG-IFN or tenofovir-based therapy should be the first-line treatment. Pros and cons of antiviral drugs should be discussed with the family before making a choice.

• In settings with limited medical resources, age-dependent approved NAs can be used as the first-line antiviral agents in children.

• In principal, a liver biopsy is required to make a decision whether to start antiviral treatment. However, a liver biopsy must not become a barrier to starting antiviral therapy.

• Antiviral treatment is not yet recommended in HBeAg-positive immune-tolerant children unless severe liver fibrosis or positive family history of HCC.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.