Drugs to Treat Chronic Hepatitis B in Children

Although a rather benign course of chronic HBV infection during childhood has been described, 3%-5% and 0.01%-0.03% of chronic carriers develop cirrhosis or HCC before adulthood. Considering the whole lifetime, the risk HCC rises to 9%-24% and the incidence of cirrhosis to 2%-3% per year. 

HBV treatment should be determined based on the phase of infection, alanine aminotransferase (ALT) level, HBV-DNA level and liver histology. In children with elevated serum ALT levels (>1.5-2 × upper normal limit [ULN]), an observation period of 6 months (12 months in anti-HBe-positive patients) is recommended. Similarly, treatment is recommended when the histopathology of the liver shows moderate necroinflammation or moderate fibrosis. 

At present, five drugs have been approved for the treatment of HBV in children, including: Interferons; Peg IFN; Entecavir; Tenofovir; Lamivudine. 

Of these five drugs, IFN and Peg IFN are the most preferred options due to finite therapy, increased chances of functional cure and lack of resistance. Additionally, some of the key points to note during treatment are: Treatment criteria: it needs to be redefined for ALT cut-off as the response is better in <2x ULN than ≥2x ULN. Age (Window of opportunity): Consider treating CHB in young children between the age group of 1 to 12 years. Immune tolerant: Normal or minimally elevated ALT.