Article

Recommendations for screening, monitoring, and referral of pediatric chronic hepatitis B.

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
PEDIATRICS (impact factor: 4.47). 10/2009; 124(5):e1007-13. DOI:10.1542/peds.2009-0567 pp.e1007-13
Source: PubMed

ABSTRACT Most children with chronic hepatitis B virus infection (persistent hepatitis B surface antigen-positive for >6 months) are asymptomatic and do not generally require treatment. These children are, however, at increased risk for severe complications later in life, including advanced liver disease and liver cancer. On November 11, 2008, the Hepatitis B Foundation, a nonprofit research and disease advocacy organization, convened a panel of nationally recognized North American pediatric liver specialists to consider and recommend an approach for the screening, monitoring, initial management, and referral of children with chronic hepatitis B. The panel developed recommendations to provide guidance to practitioners on determining what additional tests to conduct, how often to monitor on the basis of test results, and when to refer to a pediatric liver specialist to build a partnership between the practitioner and liver specialist to enhance the success of management of children with this lifelong infection.

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    Article: Treatment of children with chronic hepatitis B virus infection in the United States: patient selection and therapeutic options.
    Maureen M Jonas, Joan M Block, Barbara A Haber, Saul J Karpen, W Thomas London, Karen F Murray, Michael R Narkewicz, Philip Rosenthal, Kathleen B Schwarz, Brian J McMahon
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    ABSTRACT: Chronic hepatitis B virus (HBV) infection in children presents a therapeutic challenge for the practitioner. Decisions regarding selection of patients who may benefit from treatment, appropriate timing of treatment, and the choice of antiviral therapy are complex and are compounded by the limited number of drugs that have been studied in children. An expert panel of nationally recognized pediatric liver specialists was convened by the Hepatitis B Foundation on August 11, 2009, to consider clinical practice relative to the therapeutic options available for children. A detailed account of these discussions is provided, and the opinions expressed are based on consensus of the experts, as well as on published evidence when available. The panel concludes that, at this time, there is no established benefit of treatment of children in the immune tolerant phase, and there is a very high risk of development of drug resistance. In addition, there is no indication for treatment of children in the inactive carrier state. For children in the immune active or reactivation phases, liver histology can help guide treatment decisions, and family history of liver disease, especially hepatocellular carcinoma, may argue for early treatment in some cases. Outside of clinical trials, interferon is the agent of choice in most cases. Nucleos(t)ide analogues are secondary therapies, and children who receive these agents require careful monitoring for development of resistance. There are a few situations when treatment is indicated regardless of HBV DNA or alanine aminotransferase levels. There is still much to be elucidated about the appropriate use of HBV therapy in children. Until more clinical data and therapeutic options are available, a conservative approach is warranted.
    Hepatology 08/2010; 52(6):2192-205. · 11.66 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

>6 months
 
additional tests
 
children
 
chronic hepatitis B
 
chronic hepatitis B virus infection
 
disease advocacy organization
 
Hepatitis B Foundation
 
liver cancer
 
liver disease
 
liver specialist
 
nonprofit research
 
North American pediatric liver specialists
 
November 11
 
pediatric liver specialist
 
persistent hepatitis B surface antigen-positive
 
severe complications
 
test results