Treatment of children with chronic hepatitis B virus infection in the United States: Patient selection and therapeutic options

Jonas, Maureen M.; Block, Joan M.; Haber, Barbara; Karpen, Saul J.; London, W. Thomas; Murray, Karen F.; Narkewicz, Michael R.; Rosenthal, Philip; Schwarz, Kathleen B.; McMahon, Brian J.

doi:10.1002/hep.23934

Cited by 132 publications

(122 citation statements)

References 73 publications

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“…The results of our study confirm observations of other authors that CHB in childhood usually manifests itself as a mild liver disease; however, it can lead to cirrhosis in few, but not yet well identified, cases [1,6,7,9,12]. Since children are exposed to elevated HBV DNA levels for a longer period, they may accumulate liver injury with time and, therefore, their cumulative risk of cirrhosis and HCC may be higher than in adults [7,9].…”

Section: Discussionsupporting

confidence: 89%

“…Primary factors include, sequentially: ALT level, HBV DNA level, and liver histology [12]. Histologic assessment of the grade of inflammation and stage of fibrosis is Considering a strong correlation between ALT and AST (r = 0.96, p < 0.0001), to avoid multicolinearity, two separate multivariate models were constructed: Model I (including ALT), and Model II (including AST).…”

Section: Discussionmentioning

confidence: 99%

“…A liver biopsy is essential before making treatment decisions and for predicting the possible progression of the liver disease [11]. However, this procedure is performed only in a selected group of patients on the basis of a clinical evaluation [1,2,12]. Moreover, the data regarding histopathological features in HBV-infected children and predictors of the liver disease severity is inconsistent [7,9,11,13].…”

mentioning

confidence: 99%

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Predictors of Liver Disease Severity in Children with Chronic Hepatitis B

et al. 2016

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Background. Evaluation of the liver histology is essential for the management of chronic hepatitis B (CHB) in children.Objectives. The aim of this study was to analyze the histopathological features in children with CHB and compare them with clinical and laboratory data. Material and Methods. The study comprised 30 treatment-naïve children (mean age: 12.8 ± 2.4; mean duration of infection: 11.7 ± 2.5 years; 16/30 HBeAg-positive and 14/30 HBeAg-negative), who underwent a liver biopsy due to CHB. Liver biopsies were evaluated according to the modified Knodell score. Results. A histopathological evaluation revealed mild to severe necroinflammatory activity (mean grading: 5.4 ± 3.2) and fibrosis (mean staging: 1.7 ± 0.9), irrespective of the HBeAg-status, viral load and duration of infection. One case of cirrhosis was observed. A multiple regression analysis revealed that alanine and aspartate aminotransferase (ALT and AST) levels were associated with the necroinflammatory activity (p = 0.001 for ALT, and p = 0.006 for AST). No such correlation for fibrosis was observed; however, children with elevated AST were prone to more advanced fibrosis compared to children with normal AST level (p = 0.01). Conclusions. Children with CHB presented a wide range of liver changes over a decade after the infection. The severity of liver lesions did not differ according to the HBeAg status, viral load and duration of the infection. ALT and AST levels correlated positively with the inflammatory activity. AST seems to be a better predictor of fibrosis compared to ALT. Liver biopsy is a useful tool in evaluating the severity of liver disease in children with chronic hepatitis B, whereas clinical and laboratory parameters are weak predictors of liver injury (Adv Clin Exp Med 2016, 25, 4, 681-688).

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Predictors of Liver Disease Severity in Children with Chronic Hepatitis B

et al. 2016

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“…44 Revaccination with further 1-3 doses induces protective anti-HBs response in the majority of nonresponders. 45,46 Immuno-compromised subjects should be tested annually and revaccinated if antiHBs <10 mIU/ml. 47 Testing for celiac disease, HIV or other causes of immune deficiency might be advisable for non-responders.…”

Section: Antiviral Resistancementioning

confidence: 99%

“…All infants born to HBsAg-positive women should receive both anti-HBs immunoglobulin (HBIG) and HBV vaccines within 12 hours of birth. 45 .…”

Section: Management Of Drugmentioning

confidence: 99%