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Antiviral therapy improves HBV DNA suppression in children

In a systematic review, researchers found that antiviral therapy for the treatment of hepatitis B virus infection among children improved HBV DNA suppression and other outcomes vs. no treatment.

“The current evidence demonstrates that antiviral therapy improves the frequency of surrogate outcomes [such as alanine aminotransferase normalization, hepatitis B e antigen loss, HBV DNA suppression and HBeAg seroconversion] when compared to no or placebo treatment,” Maureen M. Jonas, MD, of the division of gastroenterology at Hunnewell Ground Boston Children's Hospital, and colleagues wrote.

The researchers searched multiple databases from 1988 to December 2014 for studies, both observational and randomized controlled trials, which enrolled children with chronic HBV treated with antiviral therapy. Fourteen studies with 1,425 children were included in the final analysis.

Overall, two cohort studies showed no significant reduction in the low risk for developing hepatocellular carcinoma or cirrhosis, whereas 12 randomized controlled trials reported intermediate outcomes.

Among the randomized controlled trials with postantiviral treatment follow-up less than 12 months, antiviral treatment improved ALT normalization (risk ratio = 2.3; 95% CI, 1.73.2), HBeAg clearance or loss (RR = 2.1; 95% CI, 1.5-3.1), HBV DNA suppression (RR = 2.9; 95% CI, 1.8-4.6), HBeAg seroconversion (RR = 2.1; 95% CI, 1.4-3.3) and HBeAg clearance (RR = 5.8; 95% CI, 1.1-31.5) compared with placebo.

In randomized controlled trials with postantiviral treatment follow-up for more than 12 months, antiviral therapy improved cumulative HBeAg clearance or loss (RR = 1.9; 95% CI, 1.7-3.1), ALT normalization (RR = 1.4; 95% CI, 1.1-1.7), HBeAg seroconversion (RR = 2.1; 95% CI, 1.3-3.5) and HBV DNA suppression (RR = 1.4; 95% CI, 1.1-1.8). It did not improve HBeAg clearance or seroconversion.

“In children with chronic HBV infection, antivirals compared to no antiviral therapy improve HBV DNA suppression and frequency of alanine aminotransferase normalization and HBeAg seroconversion,” the researchers wrote.

The researchers concluded: “Patient selection and timing of treatment are critical decisions in order to avoid overtreatment, maximize therapeutic benefit while limiting duration of therapy and minimize risk for antiviral drug resistance later in life.” – by Melinda Stevens

Disclosure: Jonas reports advising for Gilead Sciences and receiving grants from Bristol-Myers Squibb, Gilead Sciences and Roche. Please see the full study for a list of all other authors’ relevant financial disclosures.