What Are the Main Differences in the Treatment of Chronic Hepatitis B between Korean Children and Adults?

The most common misconception among physicians is that chronic hepatitis B (CHB) in children can be monitored without treatment until they become adults. The risk of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in Asian children is higher than that of western children, which can occur after suffering moderate to severe hepatitis for a prolonged period during active hepatitis (immune-clearance or immune-reactive phase), even in childhood. Therefore, timely treatment in the immune-reactive phase is crucial as delayed or no treatment in this phase results in increased incidences of liver cirrhosis (LC) or HCC.1 However, the duration of the immune-tolerance phase (hepatitis B e antigen [HBeAg] positive chronic HBV infection) is unpredictable. It may exceed three decades in patients vertically infected by HBeAg-positive mothers. Furthermore, almost 90% of children remain HBeAg-positive by the age of 10–15 years. In Korea, where genotype C is predominant, the proportion of CHB patients entering the initial period of immune-reactive phase was 11.7% in younger children < 12 years and 39.7% in children < 18 years, respectively.2 This indicates that every child with HBV will not remain a HBV carrier, and a ‘wait and see’ option could be dangerous in 2/5 of children.