[Antiviral treatment for chronic viral hepatitis B and C in children in Ostrava].

Abstract

Background: Retrospective evaluation of the frequency, efficacy, and tolerance of antiviral treatment for chronic viral hepatitis B and C (VHB, VHC) in children in Ostrava.

Material and methods: The sample included 17 children with chronic VHB, aged 3-15 years, treated with conventional interferon alpha in 1993-2008, and 11 children with chronic VHC, aged 5-17 years, of whom six were treated with interferon regimens in 1995-2016 and five used direct-acting antivirals since 2020.

Results: In the 1990s, children with chronic VHB prevailed; 12 of them were infected vertically. In the last decade, children with chronic VHC dominated, with vertical transmission found in seven children. All 17 children with chronic VHB, 15 of whom were HBeAg (hepatitis B virus e-antigen-positive), were treated with interferon alpha (IFN). HBeAg positivity disappeared in seven children during treatment or within a year after treatment and in another six patients within 15 years after treatment. Treatment tolerance was good, except for psychological problems in two children. Thirteen patients continued to be observed into adulthood, six of whom were treated with interferons or oral antivirals. HBsAg (hepatitis B virus s-antigen) disappeared in four patients aged 7-38 years. Six children with chronic VHC were treated with IFN or pegylated IFN; four received ribavirin. The virus was permanently cleared in five children, the last of whom after treatment with elbasvir and grazoprevir at the age of 18. The tolerance of IFN treatment was good, except for a 5-year-old boy who developed hypothyroidism. Direct-acting antivirals were administered to five children; the first received glecaprevir with pibrentasvir, and the other four received sofosbuvir with velpatasvir. All treatments were successful. Long-term follow-up after treatment was recommended for only three patients.

Conclusions: Antiviral treatment for chronic VHB in children has become a thing of the past thanks to VHB vaccination. However, chronic VHB persists into adulthood after infection in childhood. Currently, chronic VHC dominates in children. After successful treatment with direct-acting antivirals, further follow-up in adulthood is usually unnecessary.