Viral hepatitis in children and adolescents 1 Hepatitis B virus infection in children and adolescents
Viral hepatitis in children and adolescents 1 Hepatitis B virus infection in children and adolescents
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DOI：
10.1016/s2468-1253(19)30042-1
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发表时间：
2019-06-01
影响因子：
35.7
通讯作者：
Penazzato, Martina
中科院分区：
文献类型：
--
作者：
Indolfi, Giuseppe;Easterbrook, Philippa;Penazzato, Martina
B型肝炎病毒（HBV）感染是世界范围内急性和慢性肝病以及相关发病率和死亡率的主要原因。垂直（母婴）和水平幼儿传播是乙肝病毒传播的主要途径，是大多数慢性感染的原因，包括在发病率和死亡率最高的成年人中。出生时和婴儿期普遍接种B型肝炎疫苗是全球消除HBV感染的关键策略，在减少新的垂直感染方面非常有效。然而，在成人和儿童中扩大HBV检测和治疗的全球进展缓慢。在本系列论文中，我们总结了青少年和儿童慢性HBV感染的流行病学，自然史和治疗方面的知识，并强调了与成人HBV感染的关键差异。估计全球5岁及以下儿童HBV感染率为1.3%。大多数儿童处于感染的高复制、低炎症阶段，转氨酶正常或仅轻微升高;肝硬化和肝细胞癌罕见。虽然恩替卡韦被批准并推荐用于2-17岁的儿童，替诺福韦用于12-18岁的儿童，但建议对儿童采用保守的治疗方法。解决当前政策差距的关键行动包括：验证肝病分期的非侵入性检测;对乙肝病毒感染儿童进行更多的免疫发病机制研究;对核苷或核苷酸类似物方案的儿童进行长期随访，以指导何时开始治疗;评估乙肝病毒复制率高的儿童的不同治疗策略;以及建立儿科治疗登记处和国际联盟，以促进合作研究。
Hepatitis B virus (HBV) infection is a major cause of acute and chronic liver disease and associated morbidity and mortality worldwide. Vertical (mother-to-child) and horizontal early childhood transmission are the main routes of HBV transmission and are responsible for most chronic infections, including among adults who bear the greatest burden of morbidity and mortality. Universal hepatitis B immunisation at birth and in infancy is the key strategy for global elimination of HBV infection, and has been highly effective in reducing new vertical infections. However, global progress in scale-up of HBV testing and treatment has been slow in adults and children. In this Series paper, we summarise knowledge on the epidemiology, natural history, and treatment of chronic HBV infection in adolescents and children, and we highlight key differences from HBV infection in adults. The estimated global prevalence of HBV infection in children aged 5 years or younger is 1.3%. Most children are in the high-replication, low-inflammation phase of infection, with normal or only slightly raised aminotransferases; cirrhosis and hepatocellular carcinoma are rare. Although entecavir is approved and recommended for children aged 2-17 years, and tenofovir for those aged 12-18 years, a conservative approach to treatment initiation in children is recommended. Key actions to address current policy gaps include: validation of non-invasive tests for liver disease staging; additional immunopathogenesis studies in children with HBV infection; long-term follow-up of children on nucleoside or nucleotide analogue regimens to inform guidance on when to start treatment; evaluation of different treatment strategies for children with high rates of HBV replication; and establishment of paediatric treatment registries and international consortia to promote collaborative research.