Hepatitis B

Treatments

Most children with hepatitis B have normal liver enzymes and are not initially candidates for treatment. Treatment of hepatitis B in children includes:

• Hepatitis A vaccination. All patients with hepatitis B should be vaccinated against hepatitis A.
• Avoiding toxins. Children with hepatitis B should avoid any substances that are toxic to the liver (hepatotoxic), including some over-the-counter pain relievers, prescription medicines and certain herbs and supplements. Teens should be instructed not to drink alcohol; even moderate amounts of alcohol speed up the progression of hepatitis B. Alcohol also reduces the effectiveness of treatment.

Children with chronic hepatitis B and elevated liver enzymes can be treated, but they will need to have their liver monitored regularly to check for liver damage. The following medicines for children with chronic hepatitis B and elevated liver enzymes are being studied:

• Interferon. Interferons are proteins that the body normally makes to control the immune system and fight viruses. Interferons can be produced in pure form in a lab and given in high doses. Treatment consists of interferon injections given three times a week for a six-month period. This treatment is effective in reducing hepatitis B activity (the condition goes away) only about 10 percent of the time and comes with side effects that include:
  • Fevers
  • Chills
  • Flu-like symptoms for the first few doses
  • Low white blood cell counts
  • Depression
  • Gastrointestinal (GI) symptoms
• Lamivudine. This Food and Drug Administration (FDA)-approved medicine is given daily in pill or liquid form, and treatment is continued for a year or more. One side effect is that the medicine may cause the virus to mutate (change) so that the medicine is no longer effective; this occurs as much as 40 percent of the time, although this mutated virus does not usually appear to be very harmful. About 25 percent of treated children respond to the medicine with decreasing virus activity (hepatitis B rarely clears with this treatment). There are much better medicines for hepatitis B now available for adults and in research studies. You should discuss this with your child's gastroenterologist.
• Entecavir. Entecavir is an oral medication that interferes with the virus’ DNA. It has few side effects. It helps to make the hepatitis B inactive but does not cure it. Entecavir is only used in children with active hepatitis B.
• Tenofovir. Like entecavir, tenofovir is a medicine that interferes with the virus' DNA. However, tenofovir is only approved for use in patients aged 12 years and older.

Patients with hepatitis B should also avoid sharing razors or other sharp objects that could carry blood.