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Hepatology. 2016 Jan;63(1):307-18. doi: 10.1002/hep.28278. Epub 2015 Nov 13.

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

Author information

  • 1Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
  • 2Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI.
  • 3Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK.
  • 4Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY.
  • 5Department of Medicine, Tufts Medical Center, Boston, MA.
  • 6Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN.
  • 7Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
  • 8Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
  • 9Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
  • 10Library Public Services, Mayo Clinic, Rochester, MN.
  • 11Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN.


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.


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.

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