Clinical

Interferon plus prednisolone improves HBV seroconversion in children

Last Updated: 2006-07-12 11:55:22 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Interferon therapy with prednisolone priming can improve the time and rate of seroconversion in children who have been perinatally infected with hepatitis B virus, new research shows.

Because viral eradication is seldom achieved, the primary goal for hepatitis B carriers is seroconversion, meaning that hepatitis B e antigen (HBeAg) positivity becomes hepatitis B e antibody (anti-HBe) positivity or the loss of hepatitis B DNA. The optimal therapy for achieving this outcome in children was unclear.

In the study, reported in the Journal of Medical Virology for July, Dr. Elizabeth H. Boxall, from the West Midlands Public Health Laboratory in Birmingham, UK, and colleagues assessed the long-term outcomes of 20 children treated with 16 weeks of interferon plus 6 weeks of prednisolone; 20 received interferon monotherapy; and 8 children who were not treated. The median follow-up period was 7.5 years.

At 12 months, the active interventions were comparable to no treatment in promoting seroconversion. By 5-years, however, interferon plus prednisolone provided a much higher HBeAg to anti-HBe seroconversion rate than did the other interventions -- 54% vs. 22% for interferon monotherapy and 12% for no treatment.

Seroconversion took a median of 3.9 years and was the fastest with interferon plus prednisolone, the report indicates. A pretreatment elevation in hepatic transaminases predicted a higher rate of seroconversion. Contrary to what has been seen in many European studies, none of the children in the present study cleared hepatitis B surface antigen or produced related antibodies.

"Until further antiviral agents, such as adefovir dipivoxil, have been evaluated fully, alpha interferon, including pegylated versions, with prednisolone priming should therefore still be considered in children infected perinatally with normal or low hepatic transaminases, particularly if they have an increase in hepatic amino transaminases during prednisolone priming," the authors advise.

In the meantime, they conclude that the "treatment of chronic hepatitis B in childhood remains unsatisfactory."

J Med Virol 2006;78:888-895.