![]() In 2017 the European Association for the Study of the Liver (EASL) proposed a new nomenclature for CHB that is no more based on the concept of immune-tolerant, immune-active, immune-control, and immune-escape, which have been previously used to describe the different phases of infection. The development of complications of CHB, such as cirrhosis, hepatocellular carcinoma, and extrahepatic manifestations, is manly observed in adulthood but can also present in infancy and early childhood. HBV infection is usually asymptomatic during childhood, but sometimes acute infection could present with severe symptoms and fulminant hepatitis both in adult and children. The risk of CHB is reduced to 30% when infection occurs during the first 5 years of life and < 5% for older immunocompetent children and adults. CHB is the most common outcome (90%) of the infection acquired vertically in neonates and infants. The natural history and the long-term outcome of HBV infection acquired in childhood vary depending upon the age at infection. ![]() NATURAL HISTORY OF HBV INFECTION IN CHILDREN This narrative review will provide the framework for summarizing indications to antiviral therapy in the management of chronic HBV infection in children and adolescents. Finally, EMA has approved the use of tenofovir alafenamide for treatment of children aged 12 years and older or for children weighing more than 35 kg independent of age. Tenofovir disoproxil fumarate is approved by EMA for children aged 2 years and older and by US-FDA for treatment in children aged 12 years and older. Both United States Food and Drug Administration (US-FDA) and European Medicines Agency (EMA) have approved interferon alfa-2b for children aged 1 year and older, pegylated interferon alfa-2a and lamivudine for children aged 3 years and older, entecavir for use in children aged 2 years and older, and adefovir for use in those 12 years of age and older. The main goals of antiviral treatment for children with chronic HBV infection are to suppress viral replication and to warn the disease progression to cirrhosis and hepatocellular carcinoma, although these complications are rare in children. ![]() Although a conservative approach in children is usually recommended, different therapies exist and different therapeutic approaches are possible. Most children acquire the infection perinatally or during early childhood and develop a chronic hepatitis characterized by a high viral replication and a low-inflammation phase of infection, with normal or only slightly raised aminotransferases. Hepatitis B virus (HBV) infection is one of the main causes of morbidity and mortality worldwide. ![]()
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