Management of chronic hepatitis B in childhood | 2013 EASL

Hepatites Virais 2013

Introduction
More than 360 million persons worldwide (6% of the world population) are chronically infected by the hepatitis B virus (HBV).
Although the incidence of HBV infection has dramatically
declined since the implementation of universal immunization
programs in several countries and blood-donor screening, a significant number of children are still infected each year, often
developing chronic infection and requiring appropriate followup [1]. Despite a rather benign course of chronic hepatitis B
(CHB) during childhood and adolescence, 3–5% and 0.01–0.03%
of chronic carriers develop cirrhosis or hepatocellular carcinoma
(HCC), respectively, before adulthood [2,3]. Such a risk for HCC
rises to 9–24% when considering the whole lifetime, with an incidence of cirrhosis of 2–3% per year [4,5]. Worldwide universal
vaccination remains the goal for eliminating HBV infection and
its complications. Treatment of CHB in childhood has been hampered by the chronic delay in licensing new drugs for pediatric
use. Safe and effective antiviral therapies are available in adults,
but few are labeled for the use in children, and an accurate selection of whom to treat and the identification of the right timing for

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