[Treatment of viral hepatitis in children]. / Terapija virusnog hepatitisa u djece.

ABSTRACT

In children, the natural history of chronic hepatitis B and C is different from that in adults. There are also different guidelines on therapy. So far, only conventional interferon alfa and lamivudine have been approved for the treatment of children with chronic hepatitis B before the age of twelve. For the older ones, tenofovir and adefovir are also an option. All of them are used as monotherapy. Treatment should be carried out only in certain indications, provided by predictors that favor a positive outcome. Therapeutic goal is to stop the progression of the disease in order to reduce the risk of complications (cirrhosis and hepatocellular carcinoma) later in life. There is also no urgency to start treatment in children with chronic hepatitis C, as the disease in children generally has slow progression. Therefore, therapy is indicated in those with progressive liver disease (with a significant degree of fibrosis). The recommended treatment is a combination of pegylated interferon alfa 2b and ribavirin. For all children with chronic viral hepatitis, annual screening for hepatocellular carcinoma must also be conducted, as it has been shown that the risk is higher here than in healthy children.