Abstract
Hepatitis B virus (HBV) infections are responsible for the development of chronic hepatitis in 400 million people worldwide. Currently, no consensus exists as to when treatment should be initiated for pediatric patients. To evaluate the risks and predictive factors of success of lamivudine treatment in children with chronic, active HBV infection. Forty-three children (22 male, median age 9.6 years) chronically infected with HBV and treated between 1998 and 2008 at CHU Ste-Justine (Montreal, Quebec) were included in the present chart review study. Inclusion criteria were detectable hepatitis B surface antigen and hepatitis B e antigen (HBeAg), minimum serum alanine aminotransferase (ALT) level of two times the upper limit of normal and detectable serum HBV DNA for at least three months. Patients received lamivudine for a minimum of six months (median 14 months). Genotyping was performed. Lamivudine treatment was effective in 35% of cases (15 of 43) and overall virological response (during or after treatment) was achieved in 51% of patients. Three patients harboured suspected lamivudine-resistant mutations and five progressed to HBeAg-chronic HBV. Predictive factors for success of treatment were: younger age at beginning of treatment (P=0.05), elevated ALT levels throughout treatment duration (P=0.003) and loss of HBeAg during treatment (P=0.016). Asian origin did not affect treatment success or spontaneous viral control during follow-up. HBV genotype did not influence treatment success. Lamivudine treatment in a carefully selected cohort of HBV patients demonstrated a good rate of success and low incidence of mutation. Younger age at the beginning of treatment and high ALT levels during treatment predicted a positive outcome.
Highlights
Y Yousef, K Béland, E Mas, P Lapierre, D Bouron Dal Soglio, F Alvarez
Les facteurs prédictifs de réussite du traitement à la lamivudine chez une cohorte de patients pédiatriques infectés par le virus de l’hépatite B : une étude sur dix ans BACKGrounD: Hepatitis B virus (HBV) infections are responsible for the development of chronic hepatitis in 400 million people worldwide
No consensus exists as to when treatment should be initiated for pediatric patients. oBJECtivES: To evaluate the risks and predictive factors of success of lamivudine treatment in children with chronic, active HBV infection
Summary
Over a mean follow-up of more than four years, virological response obtained with LAM treatment was sustained in all patients except one This patient experienced a virological recurrence with elevation of HBV DNA levels one year after treatment while maintaining seroconversion-e (HBeAg−, anti-HBe+). This patient was suspected to have developed a precore mutation. Figure 1) Hepatitis B virus (HBV)-infected children who experienced successful treatment with lamivudine achieved virological response in a short period of time. Patients with a positive outcome lost a mean of 2.88 log of HBV DNA, whereas patients who did not achieve virological response with LAM lost a mean of 2.25 log (P=0.263, unpaired two-tailed t test). TABLe 2 Demographic, biochemical and viral characteristics of patients with treatment failure and successful response to treatment effective treatment
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