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Hepatitis B treatment in younger patients remains complicated

NEW ORLEANS — Hepatitis B is a global disease, and treatment remains elusive, particularly in the pediatric population, according to a presenter here at the 2012 AAP National Conference and Exhibition.

Judith A. O’Connor, MD, who is a pediatric gastroenterologist at the University of Oklahoma Health Sciences Center, said although treatment of HBV can be tricky in younger patients, it is crucial because this illness has a profound effect on their lives.

 

Judith A. O’Connor

O’Connor said all of the treatment options for HBV have limitations. Interferon’s assets include that these medications only require a limited time frame for treatment, and they have the best antibody responses, but, on the downside, they can be painful, they require three-times-a-week dosing, and this is an expensive treatment, although it is only for 1 year.

Discussing nucleoside analogues, O’Connor said these medications’ assets are that they are administered orally and are less expensive; however, these medications are administered for an indefinite time frame. Although these treatments demonstrate a low antibody response, they demonstrate high DNA loss.

O’Connor outlined good candidates for HBV screening: children born in high and intermediate endemic areas, US-born children of immigrants, children who are household and sexual contacts of HBV carriers, patients undergoing dialysis, patients who have injected drugs, those who have multiple sexual partners and pregnant women.

In babies and young children, HBV transmission can be vertical or horizontal. Ninety percent of children born to mothers with HBV and who do not receive immune prophylaxis are at risk for chronic infection, which, she said, is “profoundly different” than children born to mothers with hepatitis C, in which the virus is passed on in about 6% of patients.

Treating HBV in children is key, O’Connor said, because HBV has a “huge impact on their life. There is a social stigma associated with this illness. … For younger children, they know they have it, but they feel like they need to keep it a secret. For older children, this can be a date breaker. It also affects these children in the ability to want to participate in sports because they are worried about blood. Fortunately, they are at low risk for cancer and cirrhosis, but their risk is higher than adults because they have it for longer.”

The goals of treatment, O’Connor said, are to “eradicate the virus, develop immunity, avoid a repeat infection, cirrhosis, [hepatocellular carcinoma] and, finally, to improve the patient’s quality of life.”

For more information:

O’Connor J. Session 2142. Presented at: AAP National Conference and Exhibition; Oct. 20-23, 2012; New Orleans.

Disclosure: O’Connor reports no relevant financial disclosures.