SJ Schwarzenberg et al. JPGN 2022. 74: 431-433. Lessons Learned from Children Enrolled into the Hepatitis B Virus Research Network Multi-Center Prospective Study

This NIDDK-funded Hepatitis B Research Network (HBRN) was established in 2009 and enrolled 362 patients. 97% of participants were born in countries where HBV is endemic or in North America to mothers born from these countries.

Key points:

• Due to revised criteria for ALT values, most pediatric patients have elevated ALT and do not meet the definition of immune-tolerant
• Spontaneous flares (ALT >400 in males and >350 in females) in untreated children…did not lead to hepatic decompensation
• Hepatocellular carcinoma was not identified in this cohort, though HBRN centers reported historical experiences. Only one patient developed cirrhosis over 4 years of followup.

Clinical Recommendations from Authors:

• Screen for HBV in children with unexplained serum aminotransferases regardless of immunization history
• Screen for HBV in children with normal aminotransferases if they or their parents are from an area where HBV is endemic or other risk factors
• In those with HBV, monitor aminotransferases and HBV levels every 6 months
• Obtain genotype in children with HBV
• Consider treatment if ALT >2 x ULN over 3-6 mo. Treatment should follow AASLD guideline
• Recommend AGAINST treatment at the start of a flare
• Recommend counseling to promote healthy weight and avoidance of at-risk alcohol use

Related blog posts:

• Comprehensive 2018 AASLD Guidance for Chronic Hepatitis B
• Expanding Treatment Population in Chronic Hepatitis B?
• Why Fewer Children Have Immune-Tolerant Hepatitis B Infection Than Previously | gutsandgrowth
• Should All Pediatric Patients with Hepatitis B Undergo Routine Surveillance for Hepatocellular Carcinoma?
• Hep B-related Hepatocellular Carcinoma in Kids: 8 Needles in 4 Haystacks
• Is Tenofovir the Best Medication for Hepatitis B Infection?

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