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Treatment of hepatitis B virus-associated nephropathy in black children
Rajendra Bhimma1, Hoosen Mohamed Coovadia, Anna Kramvis
1Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of Natal, Private Bag 7, Congella 4013, South Africa. bhimma@nu.ac.za
Insights
Interferon (IFN) treatment accelerated hepatitis B virus (HBV) e antigen clearance and improved proteinuria in black children with HBV-associated nephropathy. This interferon therapy was well-tolerated and showed promising results for kidney function.
Area of Science:
- Nephrology
- Hepatology
- Pediatric Nephrology
Background:
- Hepatitis B virus (HBV)-associated nephropathy is a significant concern in children.
- The efficacy of interferon (IFN) therapy for HBV-associated nephropathy in black children remains largely unestablished.
Purpose of the Study:
- To evaluate the efficacy and safety of interferon alfa 2b (IFNalpha 2b) in treating HBV-associated nephropathy in black children.
- To assess the impact of IFNalpha 2b on viral markers, proteinuria, and renal function.
Main Methods:
- A cohort of 24 black children with biopsy-proven HBV-associated nephropathy received 16 weeks of IFNalpha 2b treatment.
- A control group of 20 patients was followed for comparison.
- Treatment response was defined by HBeAg loss, proteinuria reduction, and preserved renal/liver function.
Main Results:
- 52.6% of treated children achieved HBeAg clearance by 40 weeks, with significant proteinuria remission and preserved renal function.
- Responders showed decreased HBV DNA levels, while non-responders did not improve proteinuria or renal function.
- Control group showed minimal spontaneous HBeAg clearance (5%) and no proteinuria remission.
Conclusions:
- IFNalpha 2b treatment leads to accelerated HBeAg clearance and proteinuria remission in black children with HBV-associated nephropathy.
- IFNalpha 2b is a well-tolerated therapeutic option for this pediatric population.
- The study highlights the potential of IFNalpha 2b in managing HBV-related kidney disease in 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.