Hepatitis B und C im Kindesalter

The development of new medications and therapy regimes has expanded the therapy of hepatitis B and C during the last years. In childhood therapy of chronic hepatitis B is indicated during the high viral phase if transaminase levels are increased on several occasions or if liver fibrosis above grade 2 is present or if social conditions necessitate hepatitis B virus suppression. Treatment with α-interferon is the therapy of choice and leads to seroconversion of anti-HBe in 26–38% of patients. In non-responders or contraindications against the use of interferon lamivudin can be used. After a period of 12 months these therapies lead to seroconversion of anti-HBe in 20–25% of patients and subsequently to the loss of HBeAg and a dramatic decrease of HBV-DNA and mostly also transaminases. Nowadays, therapy with nucleoside and nucleotide analogues should be given until seroconversion to anti-HBe has been achieved but in most cases this involves a long term therapy lasting several years. Therefore, exact knowledge of the characteristics of the currently available nucleosides is crucial. Chronic hepatitis C can be cured in 50–90% of children through combined treatment with alpha-interferon and ribavirin. If treatment is unsuccessful the therapy can be repeated. Medications such as protease and polymerase inhibitors are currently being tested in clinical studies on adults and in some years could be an extension to the clinical therapy.