Paediatric chronic hepatitis B virus infection: are children too tolerant to treat?

Abstract

Aim: Guidelines for managing the hepatitis B (HB) virus infection in children are still evolving. We aimed to assess the eligibility of children with HB virus infections for treatment based on the current guidelines.Methods: This observational study took place in 2016 and focused on children with isolated chronic HB infections, who attended the paediatric hepatology units at two centres in Egypt. We recruited all treatment-na€ ıve children aged one year to 18 years who had completed at least 12 months of follow-up. Results:The study comprised 103 children aged between 1.5-18 years. Of these, 51 (50%) had the HB e antigen-positive chronic infection, 28 (27%) had the HB-negative chronic infection, 11 (11%) had the HB e antigen-positive chronic hepatitis and none had the HB e antigen-negative chronic hepatitis. The remaining 13 (12%) children did not fulfil the criteria for chronic HB definitions. Only two of the children were candidates for treatment: both had HB e antigen-positive chronic hepatitis and had undergone liver biopsies.Conclusion: Only two of the 103 children with chronic HB were eligible for treatment according to the current guidelines and every measure should be taken to prevent the HB virus infection in children.

Paediatric hepatitis B and hepatitis C virus infections: An observational study of a Danish cohort

“…In our study, 84 (71%) of the children were HBeAg‐positive and 28 of them had HBeAg‐positive hepatitis (Table 2). These findings are similar to those from a recent study from Egypt 17 . All the 28 individuals with HBeAg‐positive hepatitis had viral loads above 20.000 IU/mL and would have been candidates for treatment according to existing guidelines.…”

Successful treatment of infantile hepatitis B with lamivudine: A case report

“…Nearly 2 million children under the age of 5 years are newly infected with HBV every year, mainly through mother-to-infant transmission (MTIT)[ 2 ]. Reportedly, 80%-90% of infants (< 1 year old) infected by HBV will subsequently develop chronic hepatitis B; in comparison, 20%-30% of children infected between 1 and 5 years old and < 5% of adults will progress to chronic hepatitis B[ 3 ]. The main characteristics of infantile HBV infection are high replication and low inflammation during the perinatal period and childhood.…”

Hepatitis B virus and the paediatric liver: waiting for news on the horizon

“…The data of El‐Raziky et al. thus confirm that the largest part of the paediatric population with chronic HBV has not an available treatment at hand.…”

“…The article of El‐Raziky et al. in this issue of the Journal is timely and emblematic of the problem posed by some of the above circumstances in Egypt, an area with intermediate endemicity and excellent paediatric HBV vaccination coverage achieved since immunisation was implemented in late 1992. However, the HBV screening of pregnant Egyptian women is still not routinely performed so that perinatal transmission still occurs and represents in that country a major transmission mode.…”

“…The well‐conducted study by El‐Raziky et al. aimed to assess the eligibility of Egyptian children with HBV infections for treatment according to the current International guidelines. These are based on HBV DNA concentration, serum transaminase concentration and severity of liver disease as assessed by either non‐invasive methods or liver biopsy, as correctly summarised by the Authors in the design of their study.…”