Aims: Hepatitis B and C cause morbidity and mortality. Vertical
infection is the most important route of transmission in children and
long-term spontaneous clearance is known to be low. Children with
active disease who are at high risk to develop cirrhosis and
hepatocarcinoma were treated in our divisions.
Methods: HBV and HCV groups received for 48 weeks subcutaneous
recombinant peginterferon alfa-2a (Pegasys®) at a dosage of 100 μg/m2
once per week in combination with oral ribavirin (15 mg/kg x day
in 2 doses) for the HCV group. Physical examinations, viral load,
ALT levels and blood count were determined during the treatment
and the follow-up (3 and 6 months after the end of the treatment).
Results: HBV group: 15 patients, median age 12,5 y (4-17 y),
4 horizontal, 10 unknown and 1 sexual transmissions, all HBsAg/HBeAg
positive. 5/9 had HBeAg seroconversion with one concomitant HBsAg
seroconversion, 4 did not have seroconversion, 2 discontinued therapy
after 12 weeks because of elevated transaminase or no response to
treatment, 4 are still on therapy. HCV group: 10 patients, median age
7y (3-15 y), 8 vertical, 2 unknown transmissions. 5 genotypes 1A,
2 genotypes 1B, 3 genotypes 3A, 7/10 had negative viremia after
24 weeks of treatment (early viral response), 2 are still on therapy,
1 stopped the therapy after 36 weeks because of no response
(genotype 1A). At present, no negative viremia at 24 weeks relapsed
in the follow-up period.
Conclusion: Our patients tolerated well the therapy with minor side
effects. Weekly peginterferon was well accepted even in very young
children. We had 5/15 HBeAg seroconversion with one HBsAg
seroconversion and 7/10 early viral response with hepatitis C. In the
literature, 1/3 of children with hepatitis B have a sustained response to
therapy and 1/10 will become both HBeAg and HBsAg negative. In
hepatitis C, between 44 and 75% will have sustained viral response
according to the genotype. Therefore, in our hands, both HBV and
HCV therapies seem to be more effective than reported in the
literature, certainly due to precocious intervention.