Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines

Sokal, Étienne; Paganelli, Massimiliano; Wirth, Stéfan; Socha, Piotr; Vajro, Pietro; Lacaille, Florence; Kelly, Déirdre; Mieli‐Vergani, Giorgina

doi:10.1016/j.jhep.2013.05.016

Cited by 184 publications

(104 citation statements)

References 177 publications

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“…In children > 2 years of age, we recommend starting TDF/3TC or TDF/FTC. In children with HBV infection under 2 years of age, for whom TDF is not yet licensed, if treatment for HBV infection is not required (see treatment algorithm for paediatric patients with chronic hepatitis B infection 141), there are two options: either starting (1) 3TC/FTC‐sparing ART (unless HLA B*5701 positive this would be ABC/ZDV) in order to avoid 3TC/FTC monotherapy and selection for HBV resistance or (2) TDF‐containing ART (off‐licence TDF in this age group) with careful monitoring of TDF bone and renal toxicity.…”

Section: Coinfectionsmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

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Section: Coinfectionsmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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“…for >3–6 months) are a warning that chronic HBV infection may have entered the immune active phase [2]. In addition, if viremia declines below 2 × 10 8 copies/mL in IT patients, immune active hepatitis should be considered even if ALT levels are in the normal range [5]. In this regard, it should be noted that hepatocyte death via apoptosis and necroptosis has been observed during hepatitis B, with the former being prominent in mild forms of hepatitis.…”

Section: Introductionmentioning

confidence: 99%

Immune Tolerant Chronic Hepatitis B: The Unrecognized Risks

Kennedy

Litwin

Dolman

et al. 2017

Viruses

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Chronic infection with hepatitis B virus (HBV) progresses through multiple phases, including immune tolerant, immune active, immune control, and, in a subset of patients who achieve immune control, reactivation. The first, the immune tolerant phase, is considered to be prolonged in duration but essentially benign in nature, lacking long-term consequences, and thus not recommended for antiviral therapy. This review challenges the notion that the immune tolerant phase is truly benign and considers the possibility that events during this phase may contribute significantly to cirrhosis, hepatocellular carcinoma (HCC), and the premature death of 25% of HBV carriers worldwide. Thus, earlier treatment than recommended by current guidelines should be considered. Low therapeutic coverage exacerbated by restrictive treatment guidelines may facilitate disease progression in many patients but also increase the risk of neonatal and horizontal transmission from untreated mothers to their children. While a prophylactic vaccine exists, there are many areas worldwide where the treatment of adults and the delivery of an effective vaccination course to newborns present difficult challenges.

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“…Risk of progressive liver disease primarily applies to hepatitis B e antigen positive (HBeAg-positive) children and seroclearance of HBeAg is a key event in the natural course of disease [ 5 ]. Most children who undergo HBeAg seroconversion are defined inactive carriers, with absent or low viral replication, and usually inactive liver histology [ 5 ]. Inactive carriers with no signs of cirrhosis at seroconversion do not show disease progression over long-term follow-up (24–29 years) [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Circulating MicroRNAs in Plasma of Hepatitis B e Antigen Positive Children Reveal Liver-Specific Target Genes

Winther

Jacobsen

Mirza

et al. 2014

International Journal of Hepatology

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Background and Aim. Hepatitis B e antigen positive (HBeAg-positive) children are at high risk of severe complications such as hepatocellular carcinoma and cirrhosis. Liver damage is caused by the host immune response to infected hepatocytes, and we hypothesise that specific microRNAs play a role in this complex interaction between virus and host. The study aimed to identify microRNAs with aberrant plasma expressions in HBeAg-positive children and with liver-specific target genes. Methods. By revisiting our previous screen of microRNA plasma levels in HBeAg-positive and HBeAg-negative children with chronic hepatitis B (CHB) and in healthy controls, candidate microRNAs with aberrant plasma expressions in HBeAg-positive children were identified. MicroRNAs targeting liver-specific genes were selected based on bioinformatics analysis and validated by qRT-PCR using plasma samples from 34 HBeAg-positive, 26 HBeAg-negative, and 60 healthy control children. Results. Thirteen microRNAs showed aberrant plasma expressions in HBeAg-positive children and targeted liver-specific genes. In particular, three microRNAs were upregulated and one was downregulated in HBeAg-positive children compared to HBeAg-negative and healthy control children, which showed equal levels. Conclusion. The identified microRNAs might impact the progression of CHB in children. Functional studies are warranted, however, to elucidate the microRNAs' role in the immunopathogenesis of childhood CHB.

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Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines

Cited by 184 publications

References 177 publications

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

Immune Tolerant Chronic Hepatitis B: The Unrecognized Risks

Circulating MicroRNAs in Plasma of Hepatitis B e Antigen Positive Children Reveal Liver-Specific Target Genes

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