早期开始抗病毒治疗有助于婴儿乙型肝炎患者血清HBsAg的快速

StephenW

Early initiation of antiviral therapy contributes to a rapid and significant loss of serum HBsAg in infantile-onset hepatitis B [url=]Shishu Zhu[/url]1
, [url=]Yi Dong[/url]1
, [url=]Limin Wang[/url]1
, [url=]Weiwei Liu[/url]2
, [url=]Pan Zhao[/url]1,3,,[url=]Correspondence information about the author Pan Zhao[/url]Email the author Pan ZhaoEmail the author Pan Zhao





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DOI: https://doi.org/10.1016/j.jhep.2019.06.009
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Highlights

• •Infantile hepatitis B as an unusual yet serious condition has scarcely been studied.
• •No treatment options are proposed for infantile hepatitis B in current expert panel consensuses or clinical practice guidelines.
• •Early initiation of antiviral therapy with lamivudine can lead to a rapid and significant loss of serum HBsAg in the present subset of infants with ALT >=2 times upper limit of normal.
  

AbstractBackground & AimThere is a paucity of data regarding antiviral therapy in hepatitis B virus (HBV)-infected infants aged <1 year with elevated ALT. This study aims to assess the efficacy and safety of antiviral therapy initiated in infancy.


MethodsA real-world cohort study was conducted from January 2010 to December 2017. HBV-infected infants with persistent elevation of ALT and high viral load under 1 year of age were recruited and divided into 2 groups. Group I included 18 infants whose parents chose to initiate antiviral therapy with lamivudine before 1 year of age. Group II included 11 infants whose parents chose to initiate antiviral therapy with interferon-α after 1 year of age and not to receive any antiviral therapies before 1 year of age. The main outcome measure was rate of serum HBsAg loss at month 12 of treatment.


ResultsThere were no statistical differences between Groups I and II regarding baseline characteristics. No infants in Group II developed spontaneous HBsAg loss before 1 year of age. In Group I, the cumulative rates of HBsAg loss at month 3, 6, 9 and 12 of treatment were respectively 39%, 67%, 78% and 83%. In Group II, the cumulative rates of HBsAg loss at month 3, 6, 9 and 12 of treatment were respectively 18%, 27%, 27% and 36%. Statistical differences existed in the cumulative rates of HBsAg loss between the two groups (log-rank test, P=0.0023). No serious adverse events occurred in the study.


ConclusionEarly initiation of antiviral therapy contributes to a rapid and significant loss of HBsAg for infantile-onset hepatitis B. Further trials with larger cohorts are needed to verify our results.


Lay summaryChronicity is a serious threat to infantile hepatitis B. However, no treatment measure has been recommended for infants with onset hepatitis B in current guidelines. In order to evaluate the benefit and safety of antiviral therapy in infantile-onset hepatitis B, a real-world cohort study was conducted. Long-term follow-up results showed that early initiation of antiviral therapy with lamivudine safely led to a rapid and significant loss of serum HBsAg in the present subset of infants with ALT >=2 times upper limit of normal. Further trials with larger cohorts are needed.



Keywords:[url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Hepatitis B virus&code=jhepat-site]Hepatitis B virus[/url], [url=https://www.journal-of-hepatology.eu/action/doSearch?searchType=quick&occurrences=all<rlSrch=true&searchScope=fullSite&searchText=Antiviral therapy&code=jhepat-site]Antiviral therapy[/url], Infant

StephenW

早期开始抗病毒治疗有助于婴儿乙型肝炎患者血清HBsAg的快速和显着丧失
师叔朱1
，易东1
，Limin Wang1
，刘伟伟2
，潘昭1,3，低星号，'作者信息关于作者潘钊电子邮件作者潘钊电子邮件作者潘钊
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DOI：https：//doi.org/10.1016/j.jhep.2019.06.009
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强调

    •婴儿乙型肝炎作为一种罕见但严重的疾病几乎没有被研究过。
    •在目前的专家小组共识或临床实践指南中，没有针对婴儿乙型肝炎提出任何治疗方案。
    •拉米夫定早期开始抗病毒治疗可导致ALT> =正常上限2倍的婴儿亚组血清HBsAg迅速显着下降。

抽象
背景与目的

关于乙型肝炎病毒（HBV）感染婴儿<1岁且ALT升高的抗病毒治疗的数据很少。本研究旨在评估婴儿期开始的抗病毒治疗的有效性和安全性。
方法

从2010年1月至2017年12月进行了一项真实世界的队列研究。招募了HBV感染的婴儿，其持续升高的ALT和1岁以下的高病毒载量，并分为2组。第一组包括18名婴儿，其父母选择在1岁之前开始使用拉米夫定进行抗病毒治疗。第二组包括11名婴儿，其父母选择在1岁后开始使用干扰素-α进行抗病毒治疗，并且在1岁之前不接受任何抗病毒治疗。主要结果指标是治疗第12个月血清HBsAg消失率。
结果

关于基线特征，第I组和第II组之间没有统计学差异。 II组婴儿在1岁之前没有发生自发性HBsAg损失。在第一组中，治疗第3,6,9和12个月HBsAg消失的累积率分别为39％，67％，78％和83％。在第II组中，治疗第3,6,9和12个月的HBsAg消失累积率分别为18％，27％，27％和36％。两组间HBsAg消失累积率存在统计学差异（对数秩检验，P = 0.0023）。研究中未发生严重不良事件。
结论

早期开始抗病毒治疗有助于婴儿型乙型肝炎患者HBsAg的快速和显着丧失。需要进一步的大型队列试验来验证我们的结果。
放置摘要

慢性病对婴儿乙型肝炎是一种严重的威胁。但是，目前的指南中没有建议对乙型肝炎发病的婴儿采取治疗措施。为了评估抗病毒治疗在婴儿期乙型肝炎中的益处和安全性，进行了一项现实世界的队列研究。长期随访结果显示，拉米夫定早期开始抗病毒治疗可安全地导致ALT> =正常上限2倍的婴儿亚组血清HBsAg迅速显着下降。需要进一步的试验与更大的队列。
关键词：
乙型肝炎病毒，抗病毒治疗，婴儿

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