Antiviral therapy safe, effective in children with immune-tolerant HBV infection

Treatment with antiviral therapy is beneficial and generally tolerated in children with chronic hepatitis B virus (HBV) infection in the immune-tolerant stage, according to the results of a systematic review and meta-analysis.

A team of investigators searched multiple databases (eg, PubMed, Embase, Cochrane, Web of Science, CBM, CNKI, and Wanfang Data) for clinical trials that assessed the efficacy and safety of antiviral therapy in children (aged 1‒18 years) with immune-tolerant hepatis B viral infection from inception to February 2023. They calculated outcomes separately for single-arm and controlled studies.

Nine trials (two randomized controlled trials [RCT], three non-RCTs, and four single-arm studies), including a total of 442 patients, met the eligibility criteria.

Findings from RCTs revealed that antiviral therapy resulted in greater rates of HBsAg loss (risk ratio [RR], 6.11, 95 percent confidence interval [CI], 1.67‒22.31; p=0.006), HBsAg serologic response (RR, 5.29, 95 percent CI, 1.47‒19.07; p=0.011), and HBeAg loss (RR, 3.00, 95 percent CI, 1.35‒6.66; p=0.007) compared with the control group at the end of follow-up.

In single-arm studies, antiviral therapy resulted in pooled incidences of 24 percent (95 percent CI, ‒0.1 to 48) for HBsAg loss, 24 percent (95 precent CI, ‒0.1 to 48) for HBeAg loss, and 24 percent (95 percent CI, ‒5 to 52) for HBsAg seroconversion.

“Due to the limited quality and number of included studies, more high-quality studies are required to validate our findings,” the investigators said.