Managing Chronic Hepatitis B in Adolescents: Concerns and Treatment Options

Hepatitis B

My daughter contracted hepatitis B vertically due to my condition.
Although she received immunoglobulin at birth, she is now 14 years old and her e-antigen is still positive.
I take her for blood tests and ultrasounds every three months.
Currently, her GOT, GPT, and fetal protein levels are normal, but during the last ultrasound, the doctor mentioned that her liver appears coarse.
I am very worried about the possibility of liver cirrhosis or liver cancer.
What should be the current management approach? Are there any aggressive treatment options available in Western medicine? I read in the newspaper about Dr.
Chang Ting-Chung from National Cheng Kung University, who has had patients improve liver fibrosis after taking antiviral medication.
Is my daughter's condition suitable for this treatment? Additionally, I heard about ZC008, a traditional Chinese medicine developed by Dr.
Hsu Shih-Lan from Taichung Veterans General Hospital, claiming it can reverse liver fibrosis.
Can I give this to my daughter? A worried and anxious mother is asking.

Xin Tong De Mama, 50~59 year old female. Ask Date: 2009/02/17

Dr. Chen Shidian reply Gastroenterology and Hepatology

Dear concerned mother,
I can sense your eagerness and love! However, there is no need to be anxious; it seems that there is currently no major issue.
Just keep monitoring the situation without the need for any medication (only necessary during episodes).
The ultrasound report describing the findings as "coarse" should not be a cause for concern; it is only when it is described as "very coarse" that a liver biopsy would be recommended to confirm the degree of fibrosis.
Generally, a 14-year-old child with long-term normal liver function is unlikely to have fibrosis (fibrosis typically occurs only with long-term abnormal liver function).
Best regards,
Chen Shidian, Changhua Hospital

Reply Date: 2009/02/17

More Info

Managing chronic Hepatitis B in adolescents, especially in the context of vertical transmission, is a significant concern for both patients and their families. Your daughter, at 14 years old, is in a critical stage of her development, and the presence of HBeAg positivity indicates active viral replication, which can lead to liver damage over time.
Firstly, it’s important to understand that chronic Hepatitis B can lead to various complications, including liver fibrosis, cirrhosis, and even hepatocellular carcinoma (liver cancer). The fact that your daughter has normal liver function tests (GOT, GPT) and alpha-fetoprotein levels is reassuring, but the ultrasound findings of a "coarse" liver texture suggest some degree of liver damage or fibrosis. This is a point of concern, as it may indicate that the liver is undergoing changes that could progress if not monitored and managed appropriately.

In terms of treatment options, the current standard of care for adolescents with chronic Hepatitis B includes antiviral therapy, particularly when there is evidence of active disease (elevated liver enzymes, high HBV DNA levels, or significant liver inflammation). Antiviral medications such as tenofovir or entecavir are commonly used and have been shown to effectively suppress the virus, reduce liver inflammation, and potentially improve liver fibrosis over time. The study you mentioned regarding Dr. Zhang's work on antiviral therapy improving liver fibrosis is consistent with current medical literature, which supports the use of antiviral therapy in managing chronic Hepatitis B.

Given your daughter's situation, it would be advisable to consult with a hepatologist or a specialist in infectious diseases who has experience treating pediatric patients with chronic Hepatitis B. They can perform a thorough evaluation, including HBV DNA testing and possibly a liver biopsy or non-invasive fibrosis assessment (like FibroScan), to determine the extent of liver damage and the best course of action.

Regarding the use of traditional Chinese medicine (TCM) such as ZC008, while some patients report benefits from herbal treatments, it is crucial to approach these options with caution. The efficacy and safety of such treatments can vary widely, and they may interact with conventional medications. It is essential to discuss any herbal supplements with your daughter's healthcare provider to ensure they do not interfere with her antiviral therapy or overall liver health.

In summary, the management of chronic Hepatitis B in adolescents involves regular monitoring, potential antiviral therapy, and a multidisciplinary approach to care. It is understandable to feel anxious about your daughter's health, but with appropriate medical guidance and treatment, many patients can lead healthy lives. Regular follow-ups with her healthcare team will be vital in ensuring her liver health is maintained and any progression of disease is addressed promptly.

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