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.