SAN FRANCISCO — Although some therapies are available for treating chronic viral hepatitis, it remains unclear whether children should be treated, Frank R. Sinatra, M.D., said at a meeting on clinical pediatrics sponsored by the University of California, San Francisco.
There are good arguments on both sides of the issue, said Dr. Sinatra, director of the pediatric gastroenterology division at the University of Southern California, Los Angeles.
The arguments for treatment include:
▸ Early treatment can prevent fibrosis and cirrhosis.
▸ Children do at least as well as—and perhaps better than—adults, with current drugs.
▸ Treatment can help prevent the spread of chronic hepatitis B and hepatitis C.
▸ Many clinicians believe any chronic viral infection must be eradicated.
The arguments against treatment include:
▸ Most children with chronic viral hepatitis are asymptomatic. “It's very hard to make an asymptomatic patient feel good,” Dr. Sinatra said.
▸ Fibrosis typically develops slowly.
▸ The side effects from current treatments are significant, and include growth retardation.
▸ Current therapy has a success rate of only 50%.
▸ Even without treatment, a small number of children will experience spontaneous resolution of their chronic infection.
▸ In Dr. Sinatra's view, the best argument against treating children who appear to be doing well is that there are better drugs on the horizon. He knows of at least eight that are in phase I, phase II, or phase III clinical trials.
Whether or not a clinician decides on treatment, these children need to be followed closely for evidence of progressive liver disease and the development of hepatocellular carcinoma, he said.