LA TERAPIA DELLE EPATITI CRONICHE VIRALI DELL'ETA INFANTILE

This work reports our recent experience in the treatment of chronic hepatitis B in children using interferon (IFN). Twenty-six patients aged between 2-16 years have been studied, all receiving IFN (6 MU/mq 3 time a week) together with decreasing doses of steroid (deflazacort), starting from 1 mg/kg/day then diminishing to 0,5-0,25-0,1 mg/kg/day. The last dose on the 45th day remained unchanged until the end of the treatment. With the first half of the patients recombinant alpha-2 IFN was used, while the others received alpha lymphoblastoid IFN. The therapy was programmed for a maximum of 12 months or for 2 months after eventual seroconversion; the average was 11,2 months (range 7-12 months). Ten patients (38,4% presented seroconversion (HBeAg+ to anti-HBeAg+ ) with no more positive HBV-DNA and normalization of ALT and AST values. In half of the patients who did not respond to IFN administration, a temporary increase in transaminase levels was observed by the end of the 5th month of treatment, associated with a temporary decrease in HBV-DNA; this serological pattern may reflect the unability in such time and by such drug dosages of positive response to the therapy. On the basis of this observation, the therapeutic schedule could be modified by increasing the dosage or associating IFN with other antiviral drugs. Up to now, the liver biopsy, scheduled at 1 year from withdrawal of therapy, has been performed in 16 patients; 6 of them presented seroconversion, 4 of the last 6 presented also a clear improvement of the histological picture. On the basis of our experience, we think it useful to administer IFN in children with HBV chronic hepatitis, even at different dosages and/or in association with other drugs.