Antiviral therapy in management of chronic hepatitis B viral infection in children: A systematic review and meta-analysis.

Abstract

UNLABELLED:

Most individuals with chronic hepatitis B viral (HBV) infection acquired the infection around the time of birth or during early childhood. We aimed to synthesize evidence regarding the effectiveness of antiviral therapy in the management of chronic HBV infection in children. We conducted a comprehensive search of multiple databases from 1988 to December 2, 2014, for studies that enrolled children (<18 years) with chronic HBV infection treated with antiviral therapy. We included observational studies and randomized controlled trials (RCTs). Two independent reviewers selected studies and extracted data. In the 14 included studies, two cohort studies showed no significant reduction in the already low risk of hepatocellular carcinoma or cirrhosis and 12 RCTs reported intermediate outcomes. In RCTs with posttreatment follow-up <12 months, antiviral therapy compared to placebo improved alanine aminotransferase normalization (risk ratio [RR] = 2.3, 95% confidence interval [CI] 1.7-3.2), hepatitis B e antigen (HBeAg) clearance/loss (RR = 2.1, 95% CI 1.5-3.1), HBV DNA suppression (RR = 2.9, 95% CI 1.8-4.6), HBeAg seroconversion (RR = 2.1, 95% CI 1.4-3.3), and hepatitis B surface antigen clearance (RR = 5.8, 95% CI 1.1-31.5). In RCTs with posttreatment follow-up ≥12 months, antiviral therapy improved cumulative HBeAg clearance/loss (RR = 1.9, 95% CI 1.7-3.1), HBeAg seroconversion (RR = 2.1, 95% CI 1.3-3.5), alanine aminotransferase normalization (RR = 1.4, 95% CI 1.1-1.7), and HBV DNA suppression (RR = 1.4, 95% CI 1.1-1.8) but not hepatitis B surface antigen clearance or seroconversion.

CONCLUSION:

In children with chronic HBV infection, antivirals compared to no antiviral therapy improve HBV DNA suppression and frequency of alanine aminotransferase normalization and HBeAg seroconversion.

• Authors: Maureen M Jonas, Anna S F Lok, Brian J McMahon, Robert S Brown Jr, John B Wong, Ahmed T Ahmed, Wigdan Farah, Mohamed A Mouchli, Siddharth Singh, Larry J Prokop, Mohammad Hassan Murad, Khaled Mohammed
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 63 Issue 1 Pg. 307-18 (Jan 2016) ISSN: 1527-3350 [Electronic] United States
• PMID: 26566163 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © 2015 by the American Association for the Study of Liver Diseases.

Chemical References

• Antiviral Agents

Topics

• Antiviral Agents (therapeutic use)
• Child
• Hepatitis B, Chronic (drug therapy)
• Humans
• Randomized Controlled Trials as Topic