Effect of Lamivudine Treatment on Chronic Hepatitis B Infection in Children Unresponsive to Interferon

Abstract

Purpose: Interferon is a widely used treatment for chronic hepatitis B in children. However, additional treatment options are needed because more than 50% of hepatitis B patients are unresponsive to interferon. Although lamivudine is widely used to treat hepatitis B, there are few studies on the effect of lamivudine in hepatitis B patients unresponsive to interferon. Methods: Eight interferon unresponsive patients (6 males and 2 females) were treated with lamivudine (3 mg/kg/day, maximum 100 mg/day) from 6∼12 months after interferon treatment was discontinued among 33 children with chronic hepatitis B. They were treated with interferon (interferon α-2b, 10 MU/m or pegylated interferon 1.5μg/kg) for 6 months from January 2000 to December 2007 at the Pusan National University Hospital. The medical records were analyzed retrospectively. Results: The age at treatment with interferon and lamivudine was 4.9±3.1 and 6.1±3.2 years, respectively. The serum ALT level before treatment with interferon was 148.1±105.8 IU/L and the log HBV-DNA PCR mean value was 6.95±0.70 copies/mL. The serum ALT level after treatment with interferon was 143.1±90.4 IU/L and the log HBV-DNA mean PCR value was 6.46±2.08. HBeAg negativization occurred in 2 patients. For all patients, normalization of the serum ALT levels and HBeAg seroconversion (except 2 patients with HBeAg negativization) occurred at 7.4±2.1 and 7.9±2.1 months respectively after lamivudine treatment. The HBV-DNA PCR became negative in 7 patients (87.5%) at 2.4±2.8 months. Complete response was achieved in 7 patients and no recurrence was observed in 2 patients for 3 years after the completion of treatment. Five patients are still under treatment for a mean treatment duration of 24.4±9.1 months. In one patient, viral breakthrough occurred and the treatment was stopped. Conclusion: The number of patients was small, however, lamivudine treatment in patients with chronic hepatitis B who were unresponsive to interferon was highly effective. (Korean J Pediatr Gastroenterol Nutr 2008; 11: 137∼142)