[EASL2012]THE COURSE OF CHRONIC HBV INFECTION IN CHILDREN. WHEN SHOULD WE INITIA

StephenW

THE COURSE OF CHRONIC HBV INFECTION IN CHILDREN. WHEN SHOULD WE INITIATE ANTIVIRAL TREATMENT? A ROMANIAN 8 YEARS FOLLOW UP STUDY Speaker:
Oana Belei
Author:
O. Belei1*, I. Simedrea1, M. Pop2, L. Olariu1
Affiliation:
1First Pediatric Clinic, 2Third Pediatric Clinic, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania. *[url=mailto[email protected]][email protected][/url]
Introduction:
Natural history studies show that the risk of development chronic HBV infection is inversely proportional with age of acquisition:25% of children infected at<  5 years develop chronic infection, versus<  10% adults.In Romania, treatment of HBV infection in children is limited to lamivudine (until 2009) and alpha2b standard interferon.Treatment of all children with chronic B hepatitis must be tempered by studying the natural history in children.Spontaneous HBeAg clearance is influenced by mode of transmission, viral load, necroinflammatory activity, immunocompetence, genotype.
Aim:
To investigate the rate of HBeAg/HBsAg seroconversion during childhood, spontaneous and after antiviral treatment.
Methods:
We retrospectively studied 176 children with chronic HBV infection and +HBeAg diagnosed between 2003-2011.The route of transmission was vertical in 92 and parenteral/unknown in 84 children.The mean age at diagnosis was7,5 years (6 months-16 years). In the lot with vertical transmission, 64 children emerged from HBe+Ag mothers with high viral load and 28 from HBe-/HBs+Ag mothers with low viral load.112 children were diagnosed in the first 4 years of life. HBV markers, viral load, clinical and liver function were tested at least once every 6 months.
Results:
24 (21%) of the 112 infected infants seroconvert in “e”system before 4 years without treatment. 3 (12%) infants with spontaneous HBeAg seroconversion emerged from HBe+Ag mothers compared to 6(25%) from HBe-Ag mothers and 15(63%) from noninfected mothers (p<  0,005).No spontaneous “s system” seroconversion was detected.58 children older than 4 years (HBs+Ag/HBe+Ag, hypertransaminasemia, detectable viral load, necroinflamatory activity) started antiviral treatment. HBe+Ag seroconversion and virusologic respond rate were 48% after 12 months of Interferon and 24%, respectively 45% after 12 months, respectively 24 months of Lamivudine(p<  0,005 at one year).HBsAg clearance was obtained in 2 cases (3%) after one year of Interferon and in 1 case (1.7%) after 2 years of Lamivudine.
Conclusions:
Maternal carrier status is very important: children of HBeAg seropositive mothers have lower rates of HBeAg seroconversion. Due to the possibility of spontaneous HBeAg seroconversion, antiviral treatment shouldn't be initiated in the first 4 years of life. HBsAg clearance rate was higher but not statistic significant in children who had anti-HBeAb achieved under Interferon treatment.

StephenW

慢性乙肝病毒感染的儿童课程。我们应在何时开始抗病毒治疗？一个罗马尼亚8年的跟进研究议长：
亚通组织Belei
作者：
澳Belei1 *，M. POP2，一Simedrea1 L. Olariu1
单位：
1First 2Third儿科门诊，儿科门诊，医药维克多辣妹，蒂米什瓦拉，罗马尼亚大学。 * [email protected]~~V
简介：自然史的研究表明，开发慢性乙肝病毒感染的风险收购的年龄成反比比例：25％的儿童感染了<5年发展成慢性感染，比<10％adults.In罗马尼亚，儿童乙肝病毒感染的治疗拉米夫定是有限的（直到2009年）和所有慢性乙型肝炎的儿童alpha2b的标准interferon.Treatment必须学习在children.Spontaneous HBeAg阴转的自然历史影响的传播方式，病毒载量，坏死性炎症活动，免疫力锻炼，基因型。
目的：探讨在童年时，自发和抗病毒药物治疗后的HBeAg / HBsAg的转阴率。
方法：我们回顾性分析2003-2011.The之间的传播途径慢性乙肝病毒感染和诊断+的HBeAg的176名儿童是在92和肠外/未知的垂直平均年龄84 children.The在诊断was7，5年（6个月至16年）。在很多带有垂直传染，64名儿童出现HBE +银的母亲高病毒载量和从HBe-/HBs 28 +银低病毒load.112孩子的母亲被确诊在第4年的寿命。至少每6个月HBVmarkers，病毒载量，临床和肝功能进行了测试。
结果：24（21％）的112个受感染的婴儿中，未经处理前4年的“E”系统seroconvert。 3（12％）与自发性HBeAg血清转换HBE +银的母亲相比，婴儿出现HBe的银母亲从6（25％）和15名未感染的母亲（63％）（P <0,005）。自发的，“系统”血清转换是超过4年开始抗病毒治疗（HBs阳性+银/ HBE + Ag，hypertransaminasemia的，检测病毒负载，necroinflamatory的活动）detected.58儿童。 HBE +抗原转阴和virusologic回应率分别为48％，后12个月的干扰素和24％，分别为45％，12个月后，分别为24的拉米夫定个月（P <0,005一年）。2例（3获得HBsAg清除％）后一年干扰素和拉米夫定治疗2年后，1例（1.7％）。结论：产妇载体的地位是非常重要的：e抗原阳性母亲的儿童有HBeAg血清转换率较低。由于自发的HBeAg血清转换的可能性，抗病毒治疗不应该被启动，在第4年的生活。 HBsAg清除率较高，但没有统计学意义，有反小三阳下取得干扰素治疗的儿童。