Early Treatment Initiation Optimizes Virologic and Liver Outcomes in Pediatric Patients With Chronic Hepatitis B Aged 0 to 18 Years.

BACKGROUND & AIMS: Spontaneous hepatitis B surface antigen (HBsAg) clearance is rare in chronic hepatitis B (CHB). Identifying predictors of antiviral responses is needed.

METHODS

We retrospectively identified 1583 treatment-naive children with CHB confirmed by liver biopsy at the Fifth Medical Center of PLA General Hospital from January 2007 to April 2024. Subsequently, 852 patients received antiviral therapy and were followed up every 3 to 6 months. The median follow-up time was 3.5 years. Virological, pathological, and noninvasive tests were performed to explore predictors of antiviral response.

RESULTS

Patients in the HBsAg loss group were younger than those in the nonloss group, with a median age of 3 vs 7 years (P < .001). There were 118 (60.8%), 168 (48.3%), 26 (16.7%), and 12 (7.8%) children with CHB who achieved HBsAg clearance among those aged <3, 3 to 6, 7 to 12, and 13 to 18 years (P < .001). The hepatitis B envelope antigen (HBeAg) loss rate in children aged <3 years (83.6%) was higher than that in older children (P < .001). Compared with older children, children younger than 3 years needed a shorter median time to achieve HBsAg and HBeAg loss (41.4 and 47.4 weeks, respectively) (all P < .001). Notably, children younger than 3 years had a lower median liver stiffness measurement value (5.0 kPa) during the follow-up period, with a shorter median time (75.9 weeks) to achieve liver stiffness measurement regression (all P < .001).

CONCLUSIONS

Initiating treatment at a younger age predicts more positive and rapid hepatitis B virus clearance in children with CHB. Early intervention also improves hepatic elastography parameters in children with CHB.