Controversies in the management of pediatric liver disease: Hepatitis B, C and NAFLD: Summary of a single topic conference

Abstract

. The conference was organized to juxtapose the current state-of-the-art in the management of pediatric liver disease with evidenced-based approaches that exist for the same problems in adults. The principal goal of the conference was to assess critically current management of hepatitis B and C, and NAFLD in children, since evidence-based approaches are generally lacking. The conference included formal didactic presentations by experts (Table 1A-C) and informal active discussions between faculty and conference participants. The informal discussions were very animated and educational including both question and answer sessions and case discussions. Herein, we synthesize some of the information presented during the proceedings. Our aim with this summary is to highlight salient issues that were discussed in the STC rather than present a comprehensive review of the topics or formulate consensus statements. Individual sections have been reviewed by the faculty for that particular section, although they are not co-authors per se. The success of the conference was due in large part to the active exchange of information that took place between faculty and the participants. Hepatitis BThe complex biology and natural history of hepatitis B virus (HBV) coupled with recent advances in therapeutic approaches makes clinical decision-making in this common infection very problematic. A relatively limited published dataset related to HBV in children has left the clinician without clear-cut clinical guidelines for nearly all aspects of the care of children with chronic HBV infection. The presentations (Table 1A), case discussions and question and answer sessions at the STC highlighted marked differences in approaches to HBV infection in children by clinicians who have longstanding expertise in the management of childhood liver disease. In addition, it was also notable that the application of adult HBV guidelines to children is problematic and potentially not appropriate, since children are typically in a different stage of HBV infection and are at lower near-term risk of developing significant morbidity and mortality. 1 Currently, there are National Institutes of Health (NIH)-funded multi-center studies of hepatitis C virus (HCV) and nonalcoholic fatty liver disease (NAFLD) in children and adults but there is a notable absence of similar investigations of HBV infection in children or adults.A careful and critical understanding of the natural history of HBV infection in children is essential in making informed decisions regarding monitoring and treatment. One needs to be cognizant of the effects of HBV genotype and potential environmental effects in different regions of the world when analyzing the natural history of HBV. Thus, longitudinal data from Southeast Asia may not necessarily be applicable to Western Europe or North America. It is useful to subdivide chronic HBV infection in children into perinatal versus other modes of transmission. Perinatal transmission of HBV is typically characterized by an immunotolerant state that ...

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