Treatment of viral hepatitis B in children.

Importance of the field: Treatment of chronic hepatitis B (CHB) in children is aimed at reducing viral replication and at minimizing liver injury and related consequences in children with chronic active viral liver infection. Areas covered in this review: In this review, treatment options available for both adults and children are summarized, together with suggestions from our own experience. The most relevant works published between 1982 and 2009 on PubMed/Medline database search were used. What the reader will gain: At present, standardized treatment is available in only a few therapeutic options, such as IFN-alpha and lamivudine; it is hoped that these will be complemented in the future by new, encouraging drugs still under study in pediatric age patients. Moreover, current treatment approaches have their limitations: although IFN-alpha has been shown to be effective in patients with non-vertically-transmitted infection, HBeAg clearance while on treatment is similar to spontaneous seroconversion after long-term follow-up. IFN-alpha-induced side effects are frequent rarely severe in children. Lamivudine achieves similar results in children with active viral replication. However, despite good compliance to oral administration, this treatment can lead to the development of drug-resistant mutations. Take home message: In conclusion, the decision to treat CHB in children demands that the possibility of favorable spontaneous viral clearance has been considered and must be made on the bases of the extent of liver damage.