Which factors predict relapse after antiviral therapy cessation in paediatric CHB?

Nearly one in three children with chronic hepatitis B (CHB) who discontinued their antiviral treatment has relapsed, a study has shown.

Relapse is more common among hepatitis B e antigen (HBeAg)-positive patients and in those who need longer therapy for hepatitis B virus-deoxyribonucleic acid (HBV-DNA) to become undetectable.

In this study, the authors enrolled all hepatitis B surface antigen (HBsAG)-positive children admitted to the hospital who had been on antiviral therapy for at least 2 years with undetectable HBV-DNA and normal alanine aminotransferase (ALT) on three consecutive occasions over the last 12 months.

Treatment with antivirals was discontinued if liver biopsy showed histological activity index <5 and fibrosis (Ishak) <3.

Virological relapse referred to the elevation of HBV-DNA (>2,000 IU/mL), while biochemical relapse was defined as a rise in ALT levels to >2 times the upper limit of normal. Children with biochemical relapse were initiated on pegylated interferon alpha-2b-based sequential therapy.

One hundred fourteen children with CHB underwent screening, of which 31 who were HBsAG-positive met the eligibility criteria and stopped antiviral treatment. Twelve children (38.7 percent) had virological relapse, while five (16.1 percent) had biochemical relapse within 12 months of antiviral therapy discontinuation.

Cox regression revealed that relapse was independently predicted by the following variables: HBeAg positive status at the time of stopping antiviral therapy (hazard ratio [HR], 6.208, 95 percent confidence interval [CI], 1.630‒23.638) and longer time taken for HBV-DNA to become undetectable while on antivirals (HR, 1.027, 95 percent CI, 1.000‒1.055).