In the case of chronic hepatitis B (CHB) in children, there are currently no predetermined cutoff points for treatment. The purpose of this research was to assess the frequency of relapse following the cessation of antiviral treatment and to identify factors that may increase its risk.  All children who tested positive for hepatitis B surface antigen (HBsAg) upon presentation to a hospital were included, as were those who had been on antivirals for at least 2 years, had undetectable hepatitis B virus-deoxyribonucleic acid (HBV-DNA), and had normal alanine aminotransferase (ALT) on 3 separate occasions within the previous 12 months. When a liver biopsy revealed a histological activity index of less than 5 and fibrosis (Ishak) of less than 3, antiviral treatment was discontinued. Definitions of virological relapse included an increase in HBV-DNA (>2000 IU/mL) and biochemical relapse included an increase in ALT values (>2 times the upper limit of normal). Biochemical relapse patients were initiated on sequential therapy based on pegylated interferon α-2b. Only 31 of the 114 CHB-screened children who tested positive for HBsAg met the inclusion criteria and had their antiviral treatment discontinued. Within 12 months of finishing antiviral treatment, virological and biochemical recurrence occurred in 12 (38.5%) and 5 (16.1%) children, respectively. Cox regression analysis identified 2 independent predictors of relapse: the presence of hepatitis B e antigen (HBeAg) at the time of ending antiviral therapy (HR: 6.208, 95% CI: 1.630-23.638) and a longer latency to HBV-DNA undetectability while on antivirals (HR:1.027, 95% CI:1.000-1.055). Relapse occurred in 1/3rd of children with CHB who stopped taking antiviral medication. Those who needed more time on therapy for HBV-DNA to become undetectable and those who were HBeAg positive at the time of terminating treatment were more likely to relapse.

 

Source: journals.lww.com/pidj/Abstract/2022/09000/Incidence_and_Predictors_of_Relapse_After_Stopping.7.aspx