M1790 Pegylated Interferon Alpha-2a and Ribavirin in the Treatment of Children with Chronic Hepatitis C

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The introduction of pegylated interferons to replace recombinant ones in the treatment of adult chronic hepatitis C (CHC) patients has increased the efficacy of therapy used and improved the patients' quality of life. This study attempts to evaluate the use of pegylated interferon-alpha-2a with ribavirin in children with CHC. The participants in the study were 26 children (11 girls and 15 boys) aged 12-18 (mean age: 14.5 +1.6) infected with HCV, genotype 1 or 4. Presumed infection period varied between 1 and 12 years. 17 of the children (group I) were treated with pegylated interferon-alpha-2a and ribavirin for 48 weeks. In the remaining 9 children (group II), pegylated interferon was introduced into the ongoing therapy, after 2-8 months of treatment with recombinant interferon, and was continued until week 48. The level of HCV RNA prior to the treatment was between 2.66 x 10^4 and 4.74 x 10^6 (mean: 7.73 x 10^5 + 1.20 x 10^6), and the ALAT activity did not exceed 127 IU/mL (mean: 45 +30 IU/mL). The inflammatory activity was not higher than 2p and fibrosis than 1p, according to the modified Scheuer scale. For the assessment of the early and sustained viral response (EVR and SVR), HCV replication was measured with the use of Real-Time Polymerase Chain Reaction, RT-PCR, (TaqMan Roche). Results EVR was observed in 20 out of 26 children, including 12 from group I and 8 from group II. Sustained response to the treatment, defined as no detectable HCV replication 6 months after the end of the treatment, was seen in 16 out of 26 participating children (61%), 8 from each group. No statistically significant differences in the baseline HCV RNA and ALAT activity were observed between the responders (R) and non-responders (NR). Among the parameters analysed, the factor of crucial importance for good prognosis of response to the treatment appeared to be the presumed infection period: 3.5 + 3.4 vs. 6.5 + 3.4 (p < 0.04) for R and NR patients, respectively. In addition, that period was longer in group I as compared to group II: 5.4 + 3.7 vs. 1.6 + 1.8, respectively (p < 0.02). Adverse reactions were observed, with leucopenia being the predominant one, however, there were no cases that would require a discontinuation of the treatment. Conclusions: Pegylated interferon with ribavirin appears to be an effective and safe therapeutic alternative in children with CHC. Shorter HCV infection period seems to be indicative of a higher treatment efficacy. Further studies are needed to assess the efficacy of treatment in children converted from recombinant interferon to pegylated interferon.