1380 HYPERFERRITINEMIA: PHENOTYPIC CHARACTERISTICS, RELEVANCE OF HFE MUTATIONS AND MAGNETIC RESONANCE AMONG OUTPATIENT REFERRALS FOR ELEVATED SERUM FERRITIN

Abstract

Introduction: Natural history studies show that the risk of development chronic HBV infection is inversely proportional with age of acquisition: 25% of children infected at <5 years develop chronic infection, versus <10% adults. In Romania, treatment of HBV infection in children is limited to lamivudine (until 2009) and alpha2b standard interferon. Treatment of all children with chronic B hepatitis must be tempered by studying the natural history in children. Spontaneous HBeAg clearance is influenced by mode of transmission, viral load, necroinflammatory activity, immunocompetence, genotype. Aim: To investigate the rate of HBeAg/HBsAg seroconversion during childhood, spontaneous and after antiviral treatment. Methods: We retrospectively studied 176 children with chronic HBV infection and +HBeAg diagnosed between 2003–2011. The route of transmission was vertical in 92 and parenteral/unknown in 84 children. The mean age at diagnosis was 7.5 years (6 months to 16 years). In the lot with vertical transmission, 64 children emerged from HBe+Ag mothers with high viral load and 28 from HBe−/HBs+Ag mothers with low viral load. 112 children were diagnosed in the first 4 years of life. HBVmarkers, viral load, clinical and liver function were tested at least once every 6 months. Results: 24 (21%) of the 112 infected infants seroconvert in “e” system before 4 years without treatment. 3 (12%) infants with spontaneous HBeAg seroconversion emerged from HBe+Ag mothers compared to 6 (25%) from HBe−Ag mothers and 15 (63%) from noninfected mothers (p < 0.005).No spontaneous “s system” seroconversion was detected.58 children older than 4 years (HBs+Ag/HBe+Ag, hypertransaminasemia, detectable viral load, necroinflamatory activity) started antiviral treatment. HBe+Ag seroconversion and virusologic respond rate were 48% after 12 months of Interferon and 24%, respectively 45% after 12 months, respectively 24 months of Lamivudine (p < 0.005 at one year). HBsAg clearance was obtained in 2 cases (3%) after one year of Interferon and in 1 case (1.7%) after 2 years of Lamivudine. Conclusions: Maternal carrier status is very important: children of HBeAg seropositive mothers have lower rates of HBeAg seroconversion. Due to the possibility of spontaneous HBeAg seroconversion, antiviral treatment shouldn’t be initiated in the first 4 years of life. HBsAg clearance rate was higher but not statistic significant in children who had anti-HBeAb achieved under Interferon treatment.