Influence of antiviral therapy on the natural history of hepatitis B virus recurrence after liver transplantation: retrospective study of 14 cases

Abstract

Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. An open, randomized trial study on the therapeutic effect of recombinant α-interferon (IFNα) in 40 patients with hepatitis B virus membranous nephropathy (HBVMN) was conducted. All were pathologically proven to have HBVMN which showed no response to corticosteroid treatment represented by persistent heavy proteinuria. Both HBeAg and HBsAg were positive in all. Group 1 was composed of 20 patients who were treated with recombinant IFNα (5 subjects, body wt < 20 kg; 8 subjects, body weight ≥ 20 kg) by subcutaneous (s.c.) injection three times a week for 12 months. In group 2 there were 20 patients who received supportive treatment only. At the end of the third month of treatment, all patients in Group 1 were free of proteinuria. In contrast, 10 patients (50%) in Group 2 had persistent heavy proteinuria and another 10 patients (50%) had light proteinuria with exacerbation during respiratory tract infection. At the end of the twelfth month, 8 patients (40%) in Group 2 still had persistent heavy proteinuria and 12 patients (60%) had light proteinuria with frequent relapses. Eight patients (40%) in Group 1 had HBeAg seroconversion between the fourth and sixth months and HBsAg seroconversion between the tenth and twelfth months. HBe seroconversion only [HBeAg (-)/HBsAg (+)] was found in four patients. Four patients had no change in HBV serological markers [HBeAg (+)/HBsAg (+)]. The remaining 4 patients had HBeAg (-)/ HBeAb (+) HBsAg (-)/HBsAb (-) at the end of the twelfth month. In contrast, there was no seroconversion of HBeAg (+)/HBsAg (+) in Group 2 patients. Flu-like symptoms were found in all patients during the first two weeks of IFNα treatment and disappeared spontaneously. Psychiatric problems were late side-effects found in 30% of patients which disappeared when the dosage of IFN was reduced. These results suggest that IFNα therapy is of value in complete resolution of heavy proteinuria, and provides some benefit in seroconversion of HBeAg (+)/HBsAg (+) in children with HBVMN.