EASL Clinical Practice Guidelines

Conclusions

CHB is a mild disease in most children and adolescents. Nevertheless, a minority of patients is at risk of rapid disease progression and early development of complications, and a quarter of infected individuals develop serious complications in adult life. Treatment of patients with elevated ALT levels is overall satisfactory, but several unsolved issues need to be addressed (Table 4). IFN-α is still the treatment of choice for most children. Although in specialized centres PegIFN is currently used, this drug cannot be recommended until the results of ongoing trials become available. Licensing of highly-effective NA for older children and adolescents has opened new possibilities of treatment. Nevertheless, the risk of emergence of drug resistant strains is a public health problem and a major long-term issue for young patients. Before starting a child on NAs, therefore, the risks of treatment should be carefully weighed against the possible benefits, and treatment should be offered only to those patients who need to be treated and are likely to respond. While waiting for the results of ongoing trials, immunotolerant patients should not be treated, but monitored routinely to identify early signs of liver damage. As the management of special patient populations is problematic and not evidence-based, their referral to highly specialized centers is highly recommended.

Table 4
Unsolved issues in the management of pediatric CHB.