Carrera S, Rubino C, Bartolini E, Indolfi G. Treatment of chronic hepatitis B infection in infants and young children: A systematic review. World J Hepatol 2026; 18(4): 116657 [DOI: 10.4254/wjh.v18.i4.116657]
Corresponding Author of This Article
Simona Carrera, MD, Pediatric and Liver Unit, Meyer Children’s Hospital IRCCS, Viale Gaetano Pieraccini 24, Florence 50139, Tuscany, Italy. simona.carrera@meyer.it
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Pediatrics
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Systematic Reviews
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Apr 27, 2026 (publication date) through Apr 22, 2026
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Publication Name
World Journal of Hepatology
ISSN
1948-5182
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Carrera S, Rubino C, Bartolini E, Indolfi G. Treatment of chronic hepatitis B infection in infants and young children: A systematic review. World J Hepatol 2026; 18(4): 116657 [DOI: 10.4254/wjh.v18.i4.116657]
World J Hepatol. Apr 27, 2026; 18(4): 116657 Published online Apr 27, 2026. doi: 10.4254/wjh.v18.i4.116657
Treatment of chronic hepatitis B infection in infants and young children: A systematic review
Simona Carrera, Chiara Rubino, Elisa Bartolini, Giuseppe Indolfi
Simona Carrera, Chiara Rubino, Elisa Bartolini, Giuseppe Indolfi, Pediatric and Liver Unit, Meyer Children’s Hospital IRCCS, Florence 50139, Tuscany, Italy
Giuseppe Indolfi, Department of Neurofarba, University of Florence, Florence 50139, Tuscany, Italy
Author contributions: Indolfi G and Carrera S wrote the paper; Rubino C and Bartolini E reviewed it critically for significant intellectual content.
Conflict-of-interest statement: The authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Received: November 19, 2025 Revised: January 7, 2026 Accepted: February 3, 2026 Published online: April 27, 2026 Processing time: 155 Days and 15.3 Hours
Abstract
BACKGROUND
Chronic hepatitis B (CHB) is a significant public health problem. Most of the global burden of CHB is due to mother-to-child transmission, since perinatal infections lead to a high rate of chronicity. Spontaneous seroclearance of hepatitis B surface antigen (HBsAg) in CHB happens at a rate of 1% per year. Treatment options for CHB in children are available starting at 1 year of age. Current paediatric guidelines recommend treating children with hepatitis B envelope antigen (HBeAg) positive hepatitis with elevated serum transaminases levels for at least 6 months. Treatment is not indicated for children with HBeAg positive infection and normal transaminases. In 2024, the World Health Organization unified criteria for initiating antiviral treatment in children older than 12 years and in adults. Recent, preliminary evidence showed that antiviral therapy in infants and children younger than 2 years to 3 years of age with CHB infection led to higher rates of HBsAg loss than in adults and older children.
AIM
To evaluate the available evidence about treatment of CHB in young children and discuss the potential impact of early treatment.
METHODS
We searched the literature to identify studies reporting cases of HBsAg loss in children treated with antiviral drugs. We included only studies in which treatment-naïve patients started treatment before 2 years of age.
RESULTS
We identified 6 studies reporting results of CHB treatment, particularly HBsAg loss rates, hepatitis B virus DNA undetectability, and HBeAg loss.
CONCLUSION
Studies conducted on young children showed a higher HBsAg loss rate compared to those reached in older children and adults, offering new perspectives on the treatment of CHB. Further studies are needed to assess the effect of early treatment in larger populations and over a longer follow-up period.
Core Tip: Chronic hepatitis B is a major global health issue, largely driven by mother-to-child transmission. Spontaneous hepatitis B surface antigen seroclearance occurs at about 1% per year. Emerging evidence suggests that starting antiviral therapy at a young age might lead to higher functional cure rates. This review examines evidence and implications of early treatment.
