The effect of early antiviral therapy in infantile onset hepatitis B

In a Chinese study, infants younger than 1 year with hepatitis B
and elevated ALT were divided into 2 groups. The first group
(n=18) received lamivudine (4 mg/kg) before one year of age.
Interferon could be added if the infant did not clear the virus
before one year of age. In group 2 (n=11) treatment with interferon
was given after the infants had turned one year. Lamivudine
could be added to those who had a viral decline of less
than 2 log10 after 3 months. 9 infants in group 1 achieved loss
of HBsAg before 1 year of age and 83 % after 1 year of treatment.
In group 2, 36 % had achieved loss of HBsAg after one year.

Ref; Zhu et al. J Hepatol 2019;5:871-875

Comment: Surprisingly good results of early intervention with
antiviral therapy in infants with hepatitis B and elevated ALT.
Presently there are hardly any guidelines for the treatment of
hepatitis B in infants. If these results are correct, initiation of
antivirals should be recommended for infected infants before
one year of age.