Childhood Hepatitis B Treatment Enhances Long-Term Control of Virus

Recent research conducted by scientists at National Taiwan University has revealed that treatment for hepatitis B during childhood significantly improves the chances of achieving long-term control over the virus. This finding, published in the journal Clinical Gastroenterology and Hepatology, emphasizes the importance of early intervention in managing chronic hepatitis B virus (HBV) infections.

A functional cure for chronic HBV infection is characterized by sustained hepatitis B surface antigen (HBsAg) loss and undetectable levels of HBV DNA. Such outcomes are linked to improved health prospects for individuals living with chronic HBV, making this an important treatment goal.

The study identified several key predictors for achieving this functional cure. These include the seroconversion of hepatitis B e antigen (HBeAg) during childhood, the use of high-genetic-barrier nucleos(t)ide analog therapy before HBeAg seroconversion, and maintaining an HBsAg titer below 1,000 IU/mL following seroconversion.

This research challenges the traditional view that chronic HBV infections in children are generally benign and free from serious complications. Prior studies indicated that treating children with lamivudine could lead to increased complications in adulthood, leading many clinicians to prefer a conservative approach of monitoring without immediate treatment.

Data from a long-term follow-up study involving 413 chronic HBV patients revealed that those who experienced HBeAg seroconversion before the age of 18 and received appropriate antiviral therapy had significantly better outcomes. The cohort was monitored for over 10,000 person-years, providing robust evidence for the benefits of early treatment.

Professor Jia-Feng Wu, a lead researcher on the study, explained that earlier seroconversion is associated with fewer mutations in the basal core promoter gene, which in turn reduces the risk of developing HBeAg-negative hepatitis and liver fibrosis later in life. The current findings further solidify the connection between early treatment and achieving a functional cure.

The World Health Organization (WHO) has set an ambitious goal to treat over 80% of patients with chronic viral hepatitis by the year 2030. However, the guidelines for treating young patients, particularly children, remain underdeveloped. The results from this study suggest that initiating treatment with high-genetic-barrier nucleos(t)ide analog therapy during childhood can lead to substantial benefits for young individuals suffering from chronic HBV infections.

In conclusion, this research underscores the necessity of reevaluating treatment protocols for childhood hepatitis B infections. The insights gained from this study could significantly influence future clinical practices and recommendations, ultimately improving health outcomes for children diagnosed with chronic HBV.