Related Experiment Videos
Chronic hepatitis B in children. Natural history and treatment
1Department of Pediatrics, Fundación Jiménez Díaz, Madrid, Spain.
Insights
Interferon-alpha therapy for pediatric Hepatitis B virus (HBV) infection improved viremia clearance and liver health. Long-term follow-up shows viral DNA persistence, suggesting further treatment strategies are needed for complete HBV eradication.
Area of Science:
- Hepatology
- Virology
- Pediatric Infectious Diseases
Background:
- Hepatitis B virus (HBV) infection presents diverse clinical features in children, influenced by transmission routes and acquisition timing.
- Liver injury severity ranges from mild disease to cirrhosis and hepatocellular carcinoma, linked to viral genome replication and host immune response.
- Understanding HBV mutants and immune function is crucial for managing pediatric HBV disease.
Purpose of the Study:
- To evaluate the efficacy of antiviral therapy in children with Hepatitis B virus (HBV) infection.
- To assess the clearance of viremia and HBV sequences, and improve liver disease in pediatric patients.
- To investigate long-term outcomes and identify strategies for complete HBV eradication.
Main Methods:
- Treatment involved administering 10 MU/m2 of interferon-alpha, 3 times weekly for 6 months.
- Viral load (viremia) and HBV sequences were monitored using PCR.
- Liver histology and ALT values were assessed to evaluate liver injury and inflammation.
Main Results:
- Interferon-alpha treatment led to significantly higher viremia clearance compared to untreated patients.
- Normalized ALT values and improved liver histology were observed in the treated group.
- Long-term follow-up revealed persistent viral genome in serum and liver, with no HBsAg clearance.
Conclusions:
- Interferon-alpha therapy demonstrates benefits in managing pediatric HBV infection by reducing viral load and improving liver parameters.
- Complete eradication of HBV in children may require extended treatment durations, similar to adult cases.
- Combination antiviral therapy and immune system potentiation warrant further investigation to enhance treatment response rates.
Abstract:
Hepatitis B virus (HBV) infection in children is worldwide in distribution, but the features of HBV-associated liver disease differ depending on the route of transmission and the time of acquisition of the infection. The degree of liver injury varies from a mild disease to the development of cirrhosis and hepatocellular carcinoma, and depends on the replicative status of the viral genome. It is believed that the immune function plays a key role in the severity of HBV disease, and the impact of HBV mutants needs to be assessed. The goals of antiviral therapy in children are therefore, the clearance of viremia and HBV sequences from infected tissues, together with an improvement in the liver disease. Administration of 10 MU/m2 b.s. 3 times weekly over 6 months resulted in a significantly higher clearance of viremia, with normalization of ALT values and greater improvement in liver histology in treated than in untreated patients. Long-term follow-up of these cases reveals the presence of the viral genome in serum and liver by PCR without clearance of HBsAg. Complete eradication of HBV might need more years of evolution as for adult patients. The combination of more than one antiviral agent, as well as the potentiation of the immune system, needs to be assessed to improve the actual response rate obtained with interferon-alpha.