Early initiation of antiviral therapy improves cure of chronic hepatitis B in immune tolerant children: a real-world study

Background: There has been a lack of reliable data to support that antiviral treatment can cure the immune tolerant (IT) children with chronic hepatitis B (CHB). Therefore, this real-world observation study aimed to evaluate the safety and efficacy of IT children with CHB on early initiation of antiviral treatment. Methods This study enrolled 48 patients with CHB who were divided into treated group (n = 32) and untreated group (n = 16), all of them completed a 36-month follow-up check. Patients in treated group received either interferon-α (IFN-α) monotherapy or IFN-α add-on NAs, or IFN-α combined with NAs therapy. Results There were 18 cured cases (56.25%) and 14 uncured cases (43.75%) according to the criterion of HBsAg loss at the end of 36 months on antiviral treatment. Simultaneously, there was a rapid dynamic reduction in viral load and almost complete viral suppression in the cured IT cases at the end of month 6 from baseline compared to uncured cases. Accordingly, the rates of HBeAg or HBsAg loss and seroconversion were significantly higher in cured children than those in uncured cases. Statistical analyses indicated that there was a close correlation of HBsAg loss with younger age and a higher number of peripheral lymphocytes in IT children with antiviral treatment. Conclusion Early initiation of antiviral therapy for IT children under 6 years of age may effectively improve the cure of them. In particular, the age of 1–3 years may represent a unique and rare window for optimized response to antiviral treatment among IT children with CHB.