Age at treatment initiation predicts response in children with chronic hepatitis B

Summary Background Accumulating evidence suggests that age has a significant impact on disease progression and outcome of hepatitis B virus (HBV) infection. However, its effect on treatment response has not yet been fully elucidated. Aim To investigate the associations of age at treatment initiation with clinical treatment outcomes in children with chronic hepatitis B (CHB). Methods This study included 306 treatment‐naïve children with CHB. Participants were divided into three groups based on the age at which they started antiviral treatment: 1–3 years, 4–6 years and 7–17 years. The primary outcome of this study was HBsAg loss; secondary outcomes included HBeAg clearance and DNA undetectability. Results Of the 306 subjects, 200 (65.4%) were male. Median (IQR) duration of follow‐up was 26 (17, 42) months. There were 139 (45.4%), 79 (25.8%) and 88 (28.6%) of participants in the 1–3 years, 4–6 years and 7–17 years groups, respectively. After adjusting for other covariates, age at treatment initiation was negatively associated with the occurrence of HBsAg loss (1–3 years: HR = 5.07, 95% CI = 2.91–8.82; 4–6 years: HR = 2.42, 95% CI = 1.31–4.46) and HBeAg clearance (1–3 years: HR = 1.73, 95% CI = 1.18–2.53). In addition, we observed linear dose–responses relationships between age at treatment initiation and the probability of HBsAg loss and HBeAg clearance. Conclusions In children with CHB receiving antiviral treatment, HBsAg loss and HBeAg clearance were frequently observed. Age at treatment initiation can predict treatment response, including HBsAg loss and HBeAg clearance.