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World J Gastroenterol. Sep 28, 2021; 27(36): 6053-6063
Published online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.6053
Treatment of hepatitis B virus infection in children and adolescents
Mariangela Stinco, Chiara Rubino, Sandra Trapani, Giuseppe Indolfi
Mariangela Stinco, Chiara Rubino, Sandra Trapani, Department of Health Sciences, Pediatric Section, Meyer Children’s University Hospital, Florence 50139, Italy
Giuseppe Indolfi, Department Neurofarba, University of Florence and Meyer Children’s University Hospital, Florence 50139, Italy
Author contributions: Stinco M and Indolfi G wrote the paper; Rubino C and Trapani S reviewed it critically for significant intellectual content.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Indolfi, MD, Professor, Department Neurofarba, University of Florence and Meyer Children’s University Hospital, 6 Gaetano Pieraccini, Florence 50139, Italy. giuseppe.indolfi@meyer.it
Received: April 17, 2021
Peer-review started: April 17, 2021
First decision: June 3, 2021
Revised: June 30, 2021
Accepted: August 13, 2021
Article in press: August 13, 2021
Published online: September 28, 2021
Abstract

Hepatitis B virus (HBV) infection is one of the main causes of morbidity and mortality worldwide. Most children acquire the infection perinatally or during early childhood and develop a chronic hepatitis characterized by a high viral replication and a low-inflammation phase of infection, with normal or only slightly raised aminotransferases. Although a conservative approach in children is usually recommended, different therapies exist and different therapeutic approaches are possible. The main goals of antiviral treatment for children with chronic HBV infection are to suppress viral replication and to warn the disease progression to cirrhosis and hepatocellular carcinoma, although these complications are rare in children. Both United States Food and Drug Administration (US-FDA) and European Medicines Agency (EMA) have approved interferon alfa-2b for children aged 1 year and older, pegylated interferon alfa-2a and lamivudine for children aged 3 years and older, entecavir for use in children aged 2 years and older, and adefovir for use in those 12 years of age and older. Tenofovir disoproxil fumarate is approved by EMA for children aged 2 years and older and by US-FDA for treatment in children aged 12 years and older. Finally, EMA has approved the use of tenofovir alafenamide for treatment of children aged 12 years and older or for children weighing more than 35 kg independent of age. This narrative review will provide the framework for summarizing indications to antiviral therapy in the management of chronic HBV infection in children and adolescents.

Keywords: Hepatitis B, Children, Adolescents, Antiviral therapy, Tenofovir disoproxil fumarate, Entecavir, Interferon

Core Tip: Hepatitis B virus (HBV) is a major cause of acute and chronic liver disease. During childhood, asymptomatic chronic hepatitis B is the most common outcome of the infection, and a conservative approach is usually recommended. In selected patients there is a strict indication for treatment. Different drugs have been approved by United States Food and Drug Administration and European Medicines Agency for treatment of children and adolescents with chronic HBV infection. The main goal of the treatment is to reduce the risk of progression to cirrhosis and hepatocellular carcinoma through the suppression of HBV replication.