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

Maureen M. Jonas, Anna S.F. Lok, Brian J. Mcmahon, Robert S. Brown, John B. Wong, Ahmed T. Ahmed, Wigdan Farah, Mohamed A. Mouchli, Siddharth Singh, Larry J. Prokop, Mohammad Hassan Murad, Khaled Mohammed

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)307-318
Number of pages12
JournalHepatology
Volume63
Issue number1
DOIs
StatePublished - Jan 1 2016

ASJC Scopus subject areas

  • Hepatology

Fingerprint Dive into the research topics of 'Antiviral therapy in management of chronic hepatitis B viral infection in children: A systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this