P0341 LONG-TERM LAMIVUDINE THERAPY IN CHRONIC HBV INFECTED CHILDREN
Bildiriler > Özet Bildiri
Yazarlar: Funda ÇETİN, S. Aydogdu, ??. Altuglu, D. Nart, G. Tumgor, SADIK AKŞİT, R. V. Yagci
Journal of Pediatric Gastroenterology and Nutrition, , , Uluslararası, Özet Bildiri, Wos, cilt 39, ss S186-S187
DOI: 10.1097/00005176-200406001-00465
Özet
Introduction: To evaluate retrospectively biochemical, serological and histological response in CHB infected children who recieved combination therapy and continued with prolonged treatment with LAM. Methods: Chronic hepatitis B (CHB) infection was defined as presence of HbsAg, HbeAg and HBV DNA in serum screened at 3 months intervals for at least 1 year, serum alanine transaminase levels more than 1,5 times the normal limit and CHB with histologic activity index (HAI) more than 5 by liver biopsy. Ninety-nine children with CHB infection were treated with IFN-a (thrice-weekly, 5 MU/m2) and lamivudine (LAM, 4mg/kg/d) orally for six months. End of therapy response (CR) was defined as ALT normalization, HBV-DNA clearance and e seroconversion. Partial responders (PR) were defined as patients who had ALT normalization, HBV-DNA clearance, but who had not e seroconversion. Forty-five children with PR at the end of 6th month were continued to receive LAM alone thenceforward. Breakthrough infection was determined as re-emergence of HBV-DNA in serum after its clearance. Response rate, side effects and breakthrough infection rate were examined on prolong LAM treatment. Liver biopsy was held in 29 patients at median 32 (14–66) months of LAM; pre and post-treatment liver histology was compared. Results: Pre and post-treatment evaluation was constituted of 45 children (mean age: 11±4.2 years, 31 males (69%), 14 female (31%)) with PR at the end of 6th month of combination therapy. The initial mean ALT values and HAI scores were 75,6±60 IU/L and 8±3.3, respectively. Lamivudine was continued for median 33 months (14–66 month) and CR was achieved in 15.6% (7/45), 5,6% (2/36), 5,9% (1/17) and one patient (1/9, 11,1%)at the end of first, second, third and fourth year, respectively. Breakthrough incidence was detected in 6(13,3%) cases at 12 months and increased to 69,4% (n:25) and 82,4%(n:14) at second and third years. Patients with breakthrough continued to recieve LAM. Seroconversion and CR of the mutant virus was achieved in one patient (2.9%) at 46th month of treatment with LAM. Liver biopsy was held in 29 cases at median 32(14–66) months of LAM. Pre and post-treatment mean HAI score was 8±3.3 and 3.9±2.1, respectively (p:0,000). Mean necrosing scores were not different at the beginning and end of therapy (p:0,717). Inflamation, bridging and fibrosis scores decreased to 0.8±0.5, 1.3±1.1 and 0.6±0.8, respectively (p:0,000, p:0,002, p:0,001). Conclusion: The long-term lamivudine usage in children with PR does not induce complete response and is associated with high breakthrough incidence. However; histological improvement is achieved and/or sustained even in children with HBV-DNA breakthrough.