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VOLUME 1 , ISSUE 4 ( October-December, 2019 ) > List of Articles

Guidelines Review

Chronic Hepatitis B Management in Children

Aathira Ravindranath

Citation Information : Ravindranath A. Chronic Hepatitis B Management in Children. Ann Pediatr Gastroenterol Hepatol 2019; 1 (4):7-11.

DOI: 10.5005/jp-journals-11009-0033

License: CC BY-NC 4.0

Published Online: 04-07-2022

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Chronic hepatitis B in children is mostly due to mother-to child transmission and risk of chronicity is highest when exposed in early infancy. The infection passes through different phases depending upon the degree of activation of immune system and status of HBeAg. Accurate assessment of each phase requires measurement of HBeAg, HBV-DBA and ALT. Treatment is indicated in those who are in HBeAg positive or negative hepatitis, in those with cirrhosis and extra-hepatic manifestations. Peg IFN and nucleos(t)ide analogues (NA) are the mainstay of treatment. Peg IFN though has a finite duration of treatment has many side effects. NA therapy with high barrier against resistance have fewer side effects but duration of therapy should ideally be until loss of HBsAg as even after HBeAg seroconversion chances of seroreversal or HBeAg negative hepatitis are there. Children undergoing immunosuppression should be screened not only with HBsAg but also with AntiHBc and NA prophylaxis should be initiated in those cases with high risk of reactivation.


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  1. Batham A, Narula D, Toteja T, Sreenivas V, Puliyel JM. Sytematic review and meta-analysis of prevalence of hepatitis B in India. Indian Pediatr. 2007;44:663-74.
  2. Satapathy SK, Garg S, Chauhan R, et al. Profile of chronic hepatitis B virus in children in India: experience in 116 children. J Gastroenterol Hepatol 2006; 21: 1170-6.
  3. McMahon BJ, Alward WL, Hall DB, Heyward WL, Bender TR, Francis DP, et al. Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis 1985;151:599-603
  4. Chang M, Hsu H, Hsu H, Ni Y, Chen J, Chen D. The significance of spontaneous hepatitis B e antigen seroconversion in childhood: with special emphasis on the clearance of hepatitis B e antigen before 3 years of age. Hepatology 1995;22:1387-1392.
  5. Luo Z, Li L, Ruan B. Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period. Int J Infect Dis. 2012;16:e82.e88.
  6. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018;68:723-750.
  7. Lucifora J, Protzer U. Attacking hepatitis B virus cccDNA. The holy grail to hepatitis B cure. J Hepatol 2016;64:S41-S48.
  8. Iorio R, Giannattasio A, Cirillo F, D Alessandro L, Vegnente A. Long-term outcome in children with chronic hepatitis B: a 24-year observation period. Clin Infect Dis 2007;45:943-949.
  9. Bortolotti F, Guido M, Bartolacci S, Cadrobbi P, Crivellaro C, Noventa F, et al. Chronic hepatitis B in children after e antigen seroclearance: final report of a 29-year longitudinal study. Hepatology 2006;43:556-562.
  10. Tseng YR, Wu JF, Ni YH, Chen HL, Chen CC, Wen WH, et al. Long-term effect of maternal HBeAg on delayed HBeAg seroconversion in offspring with chronic hepatitis B infection. Liver Int 2011;31:1373-1380.
  11. Lampertico P, Agarwal K, Berg T, Buti M, Janssen HLA, Papatheodoridis G, Zoulim F, Tacke F. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398.
  12. Hsu YS, Chien RN, Yeh CT, Sheen IS, Chiou HY, Chu CM, et al. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology 2002;35:1522-1527.
  13. Tseng TC, Liu CJ, Yang HC, et al. Serum hepatitis B surface antigen levels help predict disease progression in patients with low hepatitis B virus load. Hepatology 2013;57:441-450
  14. Liu J, Yang HI, Lee MH, Lu SN, Jen CL, Batrla- Utermann R, et al. Spontaneous seroclearance of hepatitis B seromarkers and subsequent risk of hepatocellular carcinoma. Gut 2014;63:1648-1657.
  15. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398.
  16. Sokal EM, Paganelli M, Wirth S, Socha P, Vajro P, Lacaille F, Kelly D, Mieli-Vergani G. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol. 2013;59(4):814-29.
  17. Hom X, Little NR, Gardner SD, Jonas MM. Predictors of virologic response to lamivudine treatment in children with chronic hepatitis B infection. Pediatr Infect Dis J 2004;23:441-445
  18. Poddar U, Yachha SK, Agarwal J, Krishnani N. Cure for immune-tolerant hepatitis B in children: is it an achievable target with sequential combo therapy with lamivudine and interferon? J Viral Hepat. 2013;20(5):311-6.
  19. Lee HW, Lee HJ, Hwang JS, Sohn JH, Jang JY, Han KJ, et al. Lamivudine maintenance beyond one year after HBeAg seroconversion is a major factor for sustained virologic response in HBeAg-positive chronic hepatitis B. Hepatology 2010;51:415-421.
  20. D'Antiga L, Aw M, Atkins M, Moorat A, Vergani D, Mieli-Vergani G. Combined lamivudine/interferonalpha treatment in “immunotolerant” children perinatally infected with hepatitis B: a pilot study. J Pediatr. 2006;148:228-233
  21. Lal BB, Sood V, Khanna R, Rawat D, Verma S, Alam S. Pegylated interferon-based sequential therapy for treatment of HBeAg reactive pediatric chronic hepatitis B-First study in children. Indian J Gastroenterol. 2018;37(4):326-334.
  22. Rosenthal P, Ling SC, Belle SH, Murray KF, Rodriguez-Baez N, Schwarzenberg SJ et al. Combination of Entecavir/Peginterferon Alfa-2a in Children With Hepatitis B e Antigen-Positive Immune Tolerant Chronic Hepatitis B Virus Infection. Hepatology. 2019;69(6):2326-2337.
  23. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol 2016;64:433-485.
  24. Cholongitas E, Tziomalos K, Pipili C. Management of patients with hepatitis B in special populations. World J Gastroenterol 2015;21:1738-1748.
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