Natural history and clinical management of chronic hepatitis B virus infection in children

Abstract

Hepatitis B virus (HBV) infection may cause acute, fulminant, or chronic hepatitis, leading to liver cirrhosis or hepatocellular carcinoma. Despite the availability of effective vaccine, HBV infection during infancy or early childhood is common in areas of high endemicity. In these regions, mother-to-infant transmission accounts for approximately 50% of chronic infections. Although the natural history of HBV infection in adults is well characterized, little information is available in the literature regarding the natural history of HBV infection in children. Similar to infection in adults, chronic HBV infection in children can be divided into distinct phases: immune tolerant, immune clearance, and inactive carrier state. However, acute exacerbation, with reactivation of HBV replication and re-elevation of alanine aminotransferase levels after hepatitis B e antigen seroconversion, is relatively rare in children, in comparison to adults. Although several potent antiviral agents are now available for the treatment of chronic hepatitis B, experience with these agents in the pediatric setting is limited. To date, conventional interferon alpha and lamivudine are the only two antiviral agents approved to treat chronic hepatitis B in children. The rapid emergence of resistant HBV associated with long-term lamivudine therapy, as well as poor tolerability associated with conventional interferon alpha, are factors that should be considered before initiating antiviral therapy. This article reviews current knowledge regarding the natural history and treatment of chronic hepatitis B in children. Factors that affect the natural history of HBV infection in children are also reviewed.

Predictors of Liver Disease Severity in Children with Chronic Hepatitis B

“…The results of our study confirm observations of other authors that CHB in childhood usually manifests itself as a mild liver disease; however, it can lead to cirrhosis in few, but not yet well identified, cases [1,6,7,9,12]. Since children are exposed to elevated HBV DNA levels for a longer period, they may accumulate liver injury with time and, therefore, their cumulative risk of cirrhosis and HCC may be higher than in adults [7,9].…”

“…Since children are exposed to elevated HBV DNA levels for a longer period, they may accumulate liver injury with time and, therefore, their cumulative risk of cirrhosis and HCC may be higher than in adults [7,9]. However, the data regarding factors influencing liver disease progression in HBV-infected patients is inconsistent [5,6,[17][18][19].…”

“…The lifetime risk of developing HCC rises to 9-24% and the annual incidence of cirrhosis is estimated at 2-3% [1,7,8]. Therefore, infection during childhood is associated with an increased risk of morbidity and mortality from cirrhosis, decompensated liver disease, and HCC later in life [9]. A liver histopathology evaluation remains crucial for the management of liver disease in children with CHB [2,3,10].…”

“…However, this procedure is performed only in a selected group of patients on the basis of a clinical evaluation [1,2,12]. Moreover, the data regarding histopathological features in HBV-infected children and predictors of the liver disease severity is inconsistent [7,9,11,13].…”

Implementation of Occult Hepatitis Screening in the Spanish Cohort of HIV-infected Pediatric Patients

“…This may cause an immune tolerant phase in the neonate who has an immature immune system, leading to chronicity which is hypothesized to be the cause of the high rate of perinatal infection in the absence of secondary prophylaxis found on comparing infection in adults and in babies born from HBeAg-positive mothers (53).…”