Abstracts: 38th Annual Meeting of the European Society for Pediatric Gastroentrology, Hepatology and Nutrition: Porto, Portugal, June 1-4, 2005
To assess all the children with chronic Hepatitis B virus (HBV) infection (defined as persistence of AgHbs for >6 months) followed in a tertiary care centre in order to determine the pattern of transmission, natural history of the disease and response to treatment.
A retrospective chart review of the children mentioned above was conducted. The mean follow-up was 5 years. Epidemiological, past medical history, biochemical and immunological data, liver biopsy changes and effects of treatment with interferon alpha and/or lamivudine were studied. Data were analysed statistically with Fisher´s exact test (p < 0.05).
The number of children studied was 187 (median age at diagnosis 6,2 years); 65.2% were male. Transmission occurred primarily in household settings (42.7%). Ten children had extra-hepatic manifestations (4 Nephrotic S., 2 arthralgias, 2 glomerulonephritis, 1 macular rash and 1 Gianotti-Crosti S.).There was 1 co-infection with virus delta. 27.2% had liver biopsy showing evidence of fibrosis in 45%, piecemeal necrosis in 29% and cirrhosis in 5.8%. 152 (81.2%) of the children remained without any treatment and 35 (18.7%) had been treated with interferon alpha (18/51.4%) and/or lamivudine (12/34.2%); 5(14.2%) did both, sequentially. In the former group 25 (13.3%) had a spontaneous seroconversion and in the treated group only 2. Remission rate was achieved in 78 (51.3%) in the first group, as opposed to 20 (57.1%) in the second. Interferon alpha achieved 1 (5.5%) seroconversion and 14 (77.7%) remission rate. Lamivudine was responsible for 1 (8.3%) seroconversion and 4 (33.3%) remission rate. Both groups has a 50% normalization of AST/ALT. Comparing the 2 drugs showed a significant difference in the remission rate with interferon (p 0.024).
In our series of patients the most frequent pattern of transmission occurred in the household setting. In a long term basis neither interferon alpha nor lamivudine proved better than no treatment in achieving loss of AgHbs. Treatment with interferon alpha achieved higher remission rates with statistical significance but if we consider the end-point of treatment, normal AST/ALT, no difference was observed.