Rodrigo Minna, Hartley Christopher, Wasuwanich Paul, Van Trung, Karnsakul Wikrom
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
Expert Rev Anti Infect Ther. 2024 Dec;22(12):1099-1106. doi: 10.1080/14787210.2024.2412991. Epub 2024 Oct 9.
Hepatitis B virus (HBV) affects hundreds of millions globally, with many cases stemming from perinatal transmission. Chronic hepatitis B (CHB) in children can progress to cirrhosis and hepatocellular carcinoma (HCC) in adulthood. Treatment options include interferons and nucleos(t)ide reverse transcriptase inhibitors (N[t]RTIs) such as tenofovir alafenamide (TAF).
This review covers the epidemiology of pediatric CHB and current treatments, with a focus on tenofovir-based therapies, particularly tenofovir disoproxil fumarate (TDF) and TAF. TDF has been used for years, but its risks of bone mineral density loss and renal impairment have raised concerns. TAF, with lower systemic exposure, appears to mitigate these risks. Ongoing trials are evaluating TAF's safety in younger children. There are knowledge gaps in long-term safety and the potential for combination therapies.
TAF offers a safer alternative to TDF for children with CHB, showing high antiviral efficacy and fewer side effects. However, more data are needed on its use in younger children and long-term safety. The future of CHB treatment in pediatrics may include combination therapies and personalized approaches, potentially improving outcomes and minimizing risks over a lifetime of treatment. As research progresses, TAF is likely to become a cornerstone in pediatric CHB management.
全球数亿人感染乙型肝炎病毒（HBV），许多病例源于围产期传播。儿童慢性乙型肝炎（CHB）可在成年后进展为肝硬化和肝细胞癌（HCC）。治疗选择包括干扰素和核苷酸类逆转录酶抑制剂（N[t]RTIs），如替诺福韦艾拉酚胺（TAF）。
本综述涵盖儿童CHB的流行病学及当前治疗方法，重点关注基于替诺福韦的疗法，特别是富马酸替诺福韦二吡呋酯（TDF）和TAF。TDF已使用多年，但其导致骨密度降低和肾功能损害的风险引发了关注。TAF全身暴露量较低，似乎可减轻这些风险。正在进行的试验正在评估TAF在年幼儿童中的安全性。在长期安全性和联合治疗潜力方面存在知识空白。
对于CHB儿童，TAF为TDF提供了一种更安全的替代选择，显示出高抗病毒疗效且副作用更少。然而，关于其在年幼儿童中的使用和长期安全性还需要更多数据。儿科CHB治疗的未来可能包括联合治疗和个性化方法，有望在终身治疗过程中改善治疗效果并将风险降至最低。随着研究的进展，TAF可能会成为儿童CHB管理的基石。
