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Alpha-interferon treatment in HBeAg positive children with chronic hepatitis B and associated hepatitis D
A Schneider1, P Habermehl, P Gerner
1Children's Hospital of the Johannes-Gutenberg-University, Mainz.
Insights
Interferon-alpha (IFN-alpha) therapy shows promise for children with hepatitis B and D, reducing liver inflammation and improving seroconversion rates. While not affecting Hepatitis D Virus (HDV) replication, it offers a potential treatment benefit for these young patients.
Area of Science:
- Hepatology
- Virology
- Pediatric Gastroenterology
Background:
- Hepatitis B (HBV) and Hepatitis D (HDV) co-infection in children often leads to liver cirrhosis and failure within 15-20 years.
- HBeAg positivity indicates active viral replication and higher infectivity.
Purpose of the Study:
- To evaluate the efficacy of interferon-alpha (IFN-alpha) in managing HBV replication and liver inflammation in HBeAg-positive children with concurrent HDV infection.
- To compare outcomes in treated children versus historical untreated controls.
Main Methods:
- Clinical and serological data from 8 children treated with IFN-alpha were analyzed.
- Data were compared to 6 historical control patients who did not receive treatment.
Main Results:
- IFN-alpha therapy led to earlier seroconversion from HBeAg to anti-HBe in responding patients, similar to HBV-only infections.
- Serum aminotransferase levels decreased or normalized in children who achieved seroconversion.
- While HBV replication and infectivity were reduced, IFN-alpha showed no significant effect on HDV replication.
Conclusions:
- IFN-alpha therapy appears beneficial for HBeAg-positive children with co-existing HDV infection, reducing liver inflammation and promoting seroconversion.
- It represents the primary available treatment option for this specific pediatric population, offering advantages over the natural disease course.
- Long-term outcomes require further investigation, but current data suggest IFN-alpha is a valuable therapeutic choice for responders.
Abstract:
The main problem of children with HBeAg positive hepatitis B and associated hepatitis D is progression to liver cirrhosis with decompensation of liver function and need for liver replacement therapy within 15-20 years after infection. To determine whether interferon-alpha (IFN-alpha) therapy has a positive effect on HBV replication and inflammatory activity, we evaluated clinical and serological data of 8 children treated with IFN-alpha and 6 historic control patients without treatment. 4 of the nontreated patients seroconverted from HBeAg to anti-HBe between 7 to 17 years after initial diagnosis and showed decreased inflammatory activity in the liver. In the treatment group, the rate of seroconversion to anti-HBe (3 early, 2 late seroconverters) corresponded well to former trial results obtained in patients exclusively infected by HBV. Serum aminotransferase levels decreased or normalized in seroconverted children. In chronic HBV infection with associated hepatitis D (HDV) infection--compared to the spontaneous course of the disease--IFN-alpha therapy reduced inflammatory activity by earlier seroconversion to anti-HBe in responding patients. Moreover, viral replication and infectivity of hepatitis B was markedly reduced, but no effect on replication of HDV could be documented. Although long-term effects cannot be exactly estimated, at present IFN-alpha remains the only available treatment for HBeAg and anti-HDV positive children and seems to be of benefit for responding patients.