Age at treatment initiation predicts response in children with chronic hepatitis B

Predictive value of HBeAg titer dynamics for HBsAg clearance in pediatric chronic hepatitis B

Introduction

Achieving functional cure of chronic hepatitis B (CHB), characterized by the loss of HBV DNA and HBsAg, remains challenging in adults but demonstrates higher success rates in children. Elucidating the factors influencing HBsAg loss in pediatric patients is crucial for optimizing treatment strategies. This study aimed to evaluate the predictive value of HBeAg titer dynamics for HBsAg clearance in pediatric CHB and develop a predictive model incorporating these dynamics.

Material and methods

This retrospective cohort study analyzed 119 children aged 1-18 years with CHB treated with nucleos(t)ide analogues. Patient outcomes were evaluated using two independent classification approaches: HBsAg loss status and age stratification (≤6 vs. >6 years). Treatment response was assessed through longitudinal HBeAg titer measurements during the first 12 months. Based on identified predictors, a logistic regression model was developed incorporating age and HBeAg titer dynamics to predict HBsAg clearance probability.

Results

The study population exhibited a median age of 6.2 years. Factors associated with HBsAg loss encompassed younger age, female sex, and absence of breakthrough. In multivariate analysis, younger age was identified as the only significant factor. The cumulative HBsAg loss rate demonstrated markedly higher values in the ≤6 years group (Hazard ratio 7.69). HBeAg titer decline exhibited significantly steeper trajectories in the HBsAg loss group. The developed predictive model, "Log Odds = -1.182 + 0.308 × log_reduction-0.205 × age", demonstrated good performance with high accuracy.

Conclusions

Early HBeAg titer dynamics combined with age at treatment initiation may serve as useful predictors of HBsAg clearance in pediatric CHB. Our predictive model, utilizing readily available semi-quantitative HBeAg measurements, could potentially assist clinicians in therapeutic decision-making and individualized treatment strategies.

Incidence and Predictors of HBsAg Loss in Paediatric Patients With Chronic Hepatitis B Undergoing Antiviral Treatment

BACKGROUND AND AIMS

Achieving HBsAg loss is a critical clinical milestone in the management of chronic hepatitis B (CHB) towards the eradication of hepatitis B. However, there are limited researches on the incidence and determinants of HBsAg loss in paediatric CHB patients undergoing antiviral treatment. Therefore, we aimed to analyse the incidence and potential determinants of HBsAg loss in children who suffered from CHB and received antiviral treatment.

METHODS

This retrospective cohort study was performed on paediatric patients with progressive CHB who initiated either monotherapy or combination therapy using interferon/peg-interferon and entecavir. We utilised Cox regression models to evaluate the relationships between HBsAg loss and various determining factors.

RESULTS

In total of 306 subjects with an average age of 4.99 years (range 1-15) were identified in this study, of whom 200 (65.4%) were male. After a median follow-up of 26 months, HBsAg loss occurred in 135 participants. The accumulated rate of HBsAg loss was 67.8% at the end of the follow-up evaluation. Multivariate Cox regression analysis revealed that older age (HR = 0.84, 95% CI: 0.79-0.90), female sex (HR = 1.61, 95% CI: 1.13-2.30), baseline HBsAg levels (HR = 0.72, 95% CI: 0.62-0.84), HBsAb positivity (HR = 1.77, 95% CI: 1.20-2.59) and serum bilirubin levels (HR = 0.96, 95% CI: 0.92-0.99) were statistically significant predictors of HBsAg loss.

CONCLUSION

The incidence of HBsAg loss continues to increase in paediatric patients with CHB after antiviral treatment. Age, sex, baseline HBsAg and bilirubin levels and HBsAb positivity are found to be associated with sustained HBsAg loss.

Expert Consensus on the Prevention and Treatment of Chronic Hepatitis B in Children

The aim of this consensus is to standardize the prevention, diagnosis, and treatment of chronic hepatitis B in children and to achieve the goal of “eliminating viral hepatitis as a major public health threat by 2030” issued by the World Health Organization. Formulated by organized experts of the Chinese Society of Infectious Diseases and Chinese Society of Hepatology, Chinese Medical Association; Group of Infectious Diseases, Chinese Pediatric Society, Chinese Medical Association; and the National Clinical Research Center for Infectious Diseases (Beijing), the consensus provides the latest evidence and recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B in children.

Letter: Baseline age on antiviral treatment may significantly influence the clinical response of children with chronic hepatitis B

This article is linked to Wu et al papers. To view these articles, visit https://doi.org/10.1111/apt.17667 and https://doi.org/10.1111/apt.17843

Letter: Baseline age on antiviral treatment may significantly influence the clinical response of children with chronic hepatitis B - authors' reply

This article is linked to Wu et al papers. To view these articles, visit https://doi.org/10.1111/apt.17667 and https://doi.org/10.1111/apt.17830

Editorial: Time to consider early treatment for chronic hepatitis B in both children and adults

This article is linked to Wu et al papers. To view these articles, visit https://doi.org/10.1111/apt.17667 and https://doi.org/10.1111/apt.17685