When should chronic hepatitis B be treated in children?

Chronic hepatitis B in children should be treated when the infection is in the immune active stage. This is characterized by elevated serum hepatitis B virus (HBV) DNA levels, positive hepatitis B e antigen (HBeAg), and elevated liver enzymes (alanine aminotransferase or ALT). In this phase, the virus replicates actively, increasing the risk of liver damage, cirrhosis, and hepatocellular carcinoma over time. Treating children in this stage aims to suppress viral replication, improve liver function, and prevent long-term complications associated with chronic hepatitis B.

Options that involve treating solely based on abnormal liver function tests or symptoms of liver disease are not comprehensive; while these factors may indicate complications or activity, they do not necessarily characterize the immune active stage. Additionally, treating during the immune inactive stage, where the virus is not actively replicating and liver damage is unlikely, is unnecessary and can lead to potential side effects without beneficial effects. Thus, the criteria for starting treatment revolve primarily around the immune active state of the hepatitis B infection.