Treatment of children with chronic hepatitis B virus infection in the United States: patient selection and therapeutic options.
Treatment of children with chronic hepatitis B virus infection in the United States: patient selection and therapeutic options.
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DOI：
10.1002/hep.23934
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发表时间：
2010-12-01
期刊：
影响因子：
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通讯作者：
McMahon, Brian J
中科院分区：
文献类型：
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作者：
Jonas, Maureen M;Block, Joan M;McMahon, Brian J
儿童慢性乙型肝炎病毒 (HBV) 感染给从业者带来了治疗挑战。关于选择可能受益于治疗的患者、适当的治疗时机以及抗病毒治疗的选择的决定是复杂的，并且由于在儿童中研究的药物数量有限而变得更加复杂。乙型肝炎基金会于 2009 年 8 月 11 日召集了一个由全国公认的儿科肝脏专家组成的专家小组，以考虑与儿童可用治疗方案相关的临床实践。提供了这些讨论的详细说明，所表达的意见基于专家的共识以及已发表的可用证据。专家组的结论是，目前对处于免疫耐受期的儿童进行治疗尚无确定的益处，并且产生耐药性的风险非常高。此外，没有迹象表明可以对非活动携带者状态的儿童进行治疗。对于处于免疫活跃或再激活阶段的儿童，肝脏组织学可以帮助指导治疗决策，并且肝病家族史，尤其是肝细胞癌，在某些情况下可能需要早期治疗。在临床试验之外，干扰素是大多数情况下的首选药物。核苷（酸）类似物是次要疗法，接受这些药物的儿童需要仔细监测耐药性的发展。在某些情况下，无论 HBV DNA 或丙氨酸转氨酶水平如何，都需要进行治疗。关于儿童乙型肝炎治疗的适当使用还有很多有待阐明。在获得更多临床数据和治疗方案之前，需要采取保守方法。
Chronic hepatitis B virus (HBV) infection in children presents a therapeutic challenge for the practitioner. Decisions regarding selection of patients who may benefit from treatment, appropriate timing of treatment, and the choice of antiviral therapy are complex and are compounded by the limited number of drugs that have been studied in children. An expert panel of nationally recognized pediatric liver specialists was convened by the Hepatitis B Foundation on August 11, 2009, to consider clinical practice relative to the therapeutic options available for children. A detailed account of these discussions is provided, and the opinions expressed are based on consensus of the experts, as well as on published evidence when available. The panel concludes that, at this time, there is no established benefit of treatment of children in the immune tolerant phase, and there is a very high risk of development of drug resistance. In addition, there is no indication for treatment of children in the inactive carrier state. For children in the immune active or reactivation phases, liver histology can help guide treatment decisions, and family history of liver disease, especially hepatocellular carcinoma, may argue for early treatment in some cases. Outside of clinical trials, interferon is the agent of choice in most cases. Nucleos(t)ide analogues are secondary therapies, and children who receive these agents require careful monitoring for development of resistance. There are a few situations when treatment is indicated regardless of HBV DNA or alanine aminotransferase levels. There is still much to be elucidated about the appropriate use of HBV therapy in children. Until more clinical data and therapeutic options are available, a conservative approach is warranted.