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Published on: September 25, 2019
[Treatment of chronic hepatitis B in children]
1Abt. für Kinderheilkunde, Akademie Haydarpasa Gulhane, Militärisches Medizinisches Trainingskrankenhaus, Istanbul, Türkei. Arbahar@Hotmail.com
Insights
Hepatitis B virus (HBV) infection affects millions globally. Current treatments like interferon alpha show moderate remission rates, necessitating further research into combination therapies for improved outcomes in chronic hepatitis B.
Area of Science:
- Hepatology
- Virology
- Immunology
Context:
- Hepatitis B virus (HBV) infection is a significant global health concern, with over 400 million carriers worldwide.
- Infants born to HBeAg-positive mothers face a high risk (60-90%) of chronic HBV infection, potentially leading to cirrhosis and hepatocellular carcinoma.
- Effective management of chronic hepatitis B aims to suppress viral replication and achieve liver disease remission.
Purpose:
- To evaluate the efficacy of interferon alpha treatment for chronic hepatitis B.
- To assess the potential benefits of combining interferon alpha with lamivudine.
- To understand response criteria and long-term outcomes of antiviral therapy.
Summary:
- Interferon alpha offers a 36-45% remission rate in selected chronic hepatitis B patients after a four-month course.
- Good response is indicated by elevated aminotranspherase levels, HBV DNA < 200 pg/mL, and moderate/severe liver inflammation.
- While lamivudine shows promise, combination therapy requires further assessment to improve upon interferon-alpha's response rates.
Impact:
- Combination antiviral therapy needs further investigation to enhance current treatment response rates for chronic hepatitis B.
- Preliminary data on HBeAg seroconversion suggest optimism, but potential early relapses not included in studies may skew results.
- Optimizing treatment strategies is crucial to mitigate the long-term risks associated with chronic HBV infection, including liver cancer.
Abstract:
Hepatitis B virus (HBV) infection is an important health problem. It's believed that there are now at least 400 million carriers of HBV in the world. Infants born to HBeAg-positive carrier mothers have a 60% to 90% chance of contracting chronic hepatitis B infection and of possible subsequent progression to cirrhosis and hepatocellular carcinoma. Treatment of chronic hepatitis B is aimed at sustained suppression of HBV replication and remission of liver disease. Treatment with interferon alpha has a 36% to 45% remission rate after a four-month course of treatment in selected patients. The criteria of good response for the treatment include elevated aminotranspherase levels, the presence of HBV DNA but a level of less than 200 pg/mL, and a liver biopsy suggesting moderate or severe inflammatory activity. Interferon can be used alone or concurrently with lamivudine in chronic hepatitis patients. Although there were hopeful data about the efficacy of lamivudine therapy, the combination of more than one antiviral agent needs to be assessed to improve the actual response rate obtained with interferon-alpha. Preliminary reports suggest that 73% to 86% of patients remained HBeAg-negative after HBeAg seroconversion in clinical trials, but some responders who had early relapse were not included in these follow-up studies, so these results may be overly optimistic.
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