Early antiviral therapy better than later treatment in babies with hepatitis B

Early initiation of antiviral therapy leads to the rapid clearance of hepatitis B surface antigen (HBsAg) for infantile-onset infections, a new study has found.

Researchers enrolled 29 hepatitis B virus-infected infants who had persistently elevated alanine aminotransferase and high viral loads. Of these, 18 underwent lamivudine antiviral therapy before 1 year of age (group 1; median age at treatment, 8 months), as decided by their parents, while the remaining 11 initiated interferon-α therapy after they had turned 1 year (group 2; median age at treatment, 12 months).

By 3, 6, 9 and 12 months after treatment initiation, group 1 showed cumulative HBsAg clearance rates of 39 percent, 67 percent, 78 percent and 83 percent, respectively. The corresponding values in group 2 were 18 percent, 27 percent, 27 percent and 36 percent. The between-group difference after 12 months of treatment was statistically significant (p=0.0169).

Moreover, in the ensuing follow-up period, two additional patients in group 1 achieved HBsAg loss compared with none in group 2.

Only one participant, who belonged to group 2, did not eventually achieve seroconversion and accordingly terminated antiviral treatment. Off-treatment follow-up lasted for a median of 102 months, during which time no relapse had been observed.

Both treatment regimens were reasonably safe, such that no serious adverse events were reported over the course of the study. The most common side effects were fever, neutropoenia, decreased appetite, febrile convulsion and rashes.