Chronic Hepatitis B Infection: Long Term Comparison of Children Receiving Interferon Alpha and Untreated Controls

Abstract

These findings show that the overall long-term virological outcome does not differ significantly between IFN-treated and untreated children but that a significant benefit of treatment on the long term rate of HBeAg seroconversion is obtained in children with higher baseline ALT levels.

Long-term lamivudine therapy for children with HBeAg-positive chronic hepatitis B

“…5,[12][13][14][15] Treatment with lamivudine was not associated with any significant side effects. However, to enable pediatricians to be able to use this agent appropriately, it was important to evaluate treatment over a longer duration, and to evaluate the durability of the treatment response obtained.…”

“…5,[11][12][13][14][15] Treatment with interferon ␣ has the advantage of a finite duration and does not result in the emergence of HBV mutations associated with resistance. On the other hand, interferon ␣ treatment is expensive and is associated with significant side effects, including transient growth impairment.…”

Update on the Management of Pediatric Chronic Hepatitis B

“…Side effects of IFN-α treatment are numerous and occur frequently for children; however, they are rarely serious enough to warrant treatment withdrawal. Commonly reported side effects are the same as reported for adults and include transient flulike symptoms, behavioral disorders (including depression and irritability), impaired quality of life, nausea and vomiting, gastrointestinal distress (eg, diarrhea), alopecia, and bone marrow suppression (particularly neutropenia) [1,2]. Less common, but of concern, is the risk for de novo autoimmune disease.…”

“…Children in the immune active phase, with active immunological response to HBV, are more likely to respond to treatment. In the study by Vo Thi Diem et al [2], the cohort of children with loss of HBeAg (mean age 6.1 years) had a mean baseline ALT of 97.7 IU/L, compared to those who did not have HBeAg loss (ALT=57.9 IU/L). Necroinflammatory histology and low pretreatment circulating concentrations of HBV DNA also predict a long-term sustained response to IFN-α therapy [1,6,7].…”

“…Responders to treatment normalize their serum aminotransferase values and develop undetectable serum HBV DNA during treatment or following its cessation. Treatment with IFN accelerates the rate of HBeAg loss and produces sustained and durable seroconversion even after completion of treatment [19], especially among those patients with higher baseline ALT levels [2]. Although not a frequently occurring phenomenon, hepatitis B surface antigen (HBsAg) loss occurs more often among IFN-induced remission as compared with natural spontaneous seroconversion [1,20,21].…”