How is pediatric chronic hepatitis B treated?

  In China, children are mostly infected with hepatitis B virus from mother-to-child transmission, but can also be infected through other routes such as father-to-child transmission. In general, hepatitis B virus infection in children is mostly chronic carriers, but a few develop into hepatitis, even cirrhosis and liver cancer.  The age of onset of hepatitis in children can range from a few months to 12 years old, with hepatitis B being the most common. Most of them have no obvious symptoms, but their liver function is abnormal, and most of them have “major triple-positive” hepatitis B half test. Some of the children can recover normal liver function through liver preservation treatment, while others have persistent abnormal liver function. This requires antiviral treatment to solve the problem. Effective antiviral therapy blocks a series of progressive liver diseases in adulthood, and may moderate the progression of later lesions even if antiviral therapy fails to have a sustained effect. However, in actual clinical practice, some parents cannot accept antiviral therapy for fear that their children will suffer, worry about the side effects of the drugs, and other concerns, but have they considered the larger problems associated with ongoing liver damage? It is recommended that parents learn some professional knowledge to better cooperate with doctors in treatment. The case of a recently cured child with hepatitis B is provided for parents’ reference.  Li××, female, was born in March 2006.  The child was found to have abnormal liver function during a physical examination in July 2009 and did not improve with liver care treatment. The mother was positive for hepatitis B surface antigen. Physical examination: general condition was good. No yellow staining, no liver palms or spider nevi were seen. The liver was subcostal and marginal, soft in texture. The spleen was not reached. Laboratory examination: liver function was obviously abnormal, hepatitis B two-to-one half “major triplet”, HBV DNA 9×107copies/ml. Treatment: oral lamivudine treatment on December 26, 2009, combined with common interferon treatment on February 20, 2010. liver function was basically normal in October 2010. In October 2010, the liver function was basically normal, and the hepatitis B half test: anti-HBs positive, anti-Hbe positive, anti-HBc positive, HBV DNA less than 4.2×102copies/ml. Characteristics of this child’s condition: young child with delayed liver function, active hepatitis B virus replication, mother-to-child transmission. This is a lucky child who has been “cured” with the combination of interferon and lamivudine, which is often referred to as the Olympic “gold medal”. Usually the easy target is the “silver medal”, that is, normal liver function, hepatitis B “major triple” to “minor triple”, and undetectable HBV DNA.  At present, the anti-hepatitis B virus drugs are divided into two categories: one is interferon, including ordinary interferon and long-acting interferon, which requires injection therapy; the second is nucleoside drugs including lamivudine, adefovir, entecavir, tipifudine and tenofovir marketed in Europe and the United States, all for once-daily oral medication. The drugs with more experience for use in children with chronic hepatitis B are interferon and lamivudine, and adefovir has also been reported in the literature for use in children. Other drugs have not been used in children and more research is needed. The usual regimen of choice for the treatment of chronic hepatitis B in children is interferon, which varies in duration from 1 year to a long course and requires injections, once every other day for regular interferon and once a week for long-acting interferon. Interferon has some side effects, but the vast majority of children can tolerate it well. Treatment with lamivudine is also an option, with a course of 2 years or more perhaps requiring long-term treatment. This drug is easy to take orally and has few side effects, but has problems such as a long course of drug resistance. In this case, a combination regimen of interferon and lamivudine was used to obtain the desired treatment effect using the respective advantages of the 2 drugs.