Suppression of hepatitis B surface antigen production by combination therapy with nucleotide analogues and interferon in children with genotype C hepatitis B virus infection

Aim Sustained suppression of hepatitis B surface antigen (HBsAg) production after interferon (IFN) treatment has not been reported for children with genotype C chronic hepatitis B virus (HBV) infection, which is prevalent in Asia. Among children with hepatitis B envelope antigen‐positive genotype C chronic HBV infection, we compared the efficacy of combination therapy with nucleotide analogues and IFN‐α in 11 children with 12 historical cases treated with IFN monotherapy. Methods The combination of lamivudine and conventional IFN‐α was introduced for the first three patients; the other eight patients were treated with entecavir and pegylated IFN. Results Demographic factors as well as baseline HBsAg titers and HBV‐DNA levels were similar between the two groups. In the combination therapy group, viral loads were suppressed in 9/11 to below 4.0 log copies/mL both at the end of the therapy (EOT) and at 6 months after EOT. In contrast, in the IFN monotherapy group, suppression of viral loads was observed in 2/12 and 3/12 at EOT and at 6 months after EOT, respectively. In the combination therapy group, HBsAg titers dropped from 4.03 at pretreatment to 2.91 log IU/mL at 6 months after EOT with 4/11 showing a drop to below 1000 IU/mL (one patient achieved HBsAg clearance). In contrast, the amount of HBsAg did not change during the corresponding periods in the IFN monotherapy group. Conclusions Our preliminary results suggest that combination therapy might be effective in the suppression of HBsAg production as well as HBV‐DNA production for children with genotype C chronic HBV infection.