engleski

Hepatitis B in children

Although the incidence of hepatitis B virus infection has dramatically declined since the implementation of universal immunization programs and blood-donor screening, still a significant number of children are infected each year, often developing chronic infection and requiring appropriate follow-up. The natural history of chronic hepatitis B virus infection in children is variable, depending upon age at time of infection, mode of acquisition, genotype, host immune status and level of viral replication. The diagnosis of hepatitis B is made by serologic testing for HBsAg and anti-HBc. The presence of HBsAg indicates hepatitis B virus infection, and the presence of IgG anti-HBc (with negative IgM anti-HBc) indicates that the infection is chronic. Patients with serologic evidence of HBV should be further evaluated with aminotransferases, HBV DNA and HBeAg. Other causes of liver disease should be excluded. Only carefully selected patients with chronic hepatitis B should be treated during childhood. This is because the clinical approach to infected children is still evolving and none of the available treatments is highly efficacious. Furthermore, under some circumstances, treatment is associated with a high likelihood of drug resistance. Therefore, the choice of whether to treat depends on several patient- specific characteristics which predict the efficacy of treatment, including persistently abnormal ALT levels, and active disease shown on liver biopsy (if performed), HBV DNA level and comorbidities. When a decision to treat has been made, either interferon alpha or nucleoside/nucleotide analogues can be used. Children with chronic hepatitis B should be surveyed periodically for development of hepatocellular carcinoma (yearly right upper quadrant ultrasound and alpha- fetoprotein level).

chronic liver disease ; hepatitis B virus ; infection in children

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