Treatment of hepatitis B virus-associated nephropathy in black children

Abstract

The efficacy of interferon (IFN) in the treatment of hepatitis B virus (HBV)-associated nephropathy in black children has not been established. Twenty-four black children with biopsy-proven HBV-associated nephropathy were recruited into the study during the period April 1997 to June 1999. Five defaulted treatment and were excluded from the primary analysis. IFNalpha 2b was administered for 16 weeks. Response to treatment was defined as loss of HBeAg, decrease in proteinuria, and prevention of deterioration in renal and liver function. A control group of 20 patients was followed up for the same period. Ten (52.6%) of the treated children responded with clearance of HBeAg by 40 weeks. None cleared HBsAg. All responders showed remission of proteinuria, 90% maintained normal renal function and 1 (10%) showed improvement of renal function. HBV DNA levels decreased in this group. Nine patients did not clear HBeAg; none showed remission of proteinuria, and two showed deterioration of renal function. Liver enzymes rose during treatment but subsequently declined irrespective of response to therapy. No serious side effects were encountered. Only 5% of controls showed spontaneous clearance of HBeAg, and none had remission of proteinuria. Black children with HBV-associated nephropathy show accelerated clearance of HBeAg with remission of proteinuria following treatment with IFNalpha 2b. IFNalpha 2b was well tolerated.

Treatment of Hepatitis B Virus-Associated Nephropathy

“…None of the 9 patients who did not clear HBeAg showed remission of proteinuria, while 2 developed progressive renal failure. In the control group, only 5% of the patients showed spontaneous clearance of HBeAg, and none had remission of proteinuria [41]. These studies support the notion that antiviral therapy is effective in inducing proteinuria remission and preserving renal function in patients with HBV-associated MN.…”

“…In contrast, none of the patients treated conservatively underwent seroconversion. On the other hand, in the only study to report on the effect of interferon-α 2 b in 24 African children with HBV-associated MN, 10 of the children who completed 16 weeks of therapy (52.6%) responded with clearance of HBeAg by 40 weeks [41]. None cleared HBsAg.…”

Chronic renal failure in children: a report from Port Harcourt, Nigeria (1985–2000)

“…A low incidence of HBV was found in this study, unlike in Durban with a high prevalence of HBV nephropathy [16,17]. Although HIV screening was not performed in any of the patients, mainly due to financial reasons, previous reports from South Africa showed that HIV-associated nephropathy is uncommon in children, because of their demise before they develop nephropathy as adults [5].…”

Renal Dysfunction and Liver Transplantation

“…Disease remission is especially evident after HBeAg seroconversion. A significant percent of adults (30%) may progress to renal failure and as many as 10% will require maintenance dialysis (Bhimma et al, 2002).…”