THERAPY FOR CHRONIC VIRAL-HEPATITIS

Treatment of chronic hepatitis B and C aims to achieve viral eradicati on. Decreasing the number of carriers subsequently reduces the transmi ssion of the viruses. For an individual patient, therapy is aimed at p reventing cirrhosis, liver failure and hepatocarcinoma. Among potentia l therapies, interferon alfa offers the best results. In one study inv olving the treatment of children from a region of intermediate endemic ity, interferon alfa accelerated the clearance of hepatitis B virus (H BV) replication. In long-term follow-up, the study did not show a sign ificant difference between patients who were treated and those who wer e not in the rate of disappearance of serum HBV-DNA, normalization of alanine aminotransferase (ALT) levels or seroconversion to antibodies to hepatitis B e antigen. The most important factors in predicting a r apid decrease in HBV replication were ALT levels more than twice norma l, low levels of serum HBV-DNA (less than 100 pg/mL) and inflammatory activity on liver biopsy (chronic active hepatitis). A select group of children with HBV infection has thus been shown to benefit from inter feron alfa therapy. Treatment should be administered in a dosage of 6 MU/m(2) three times each week for 6 months. Chronic active hepatitis d evelops in approximately 30% of children with a chronic hepatitis C vi rus (HCV) infection. Cirrhosis due to HCV appears to be a very rare co mplication among children. Results of interferon alfa treatment for ch ildren with HCV are scarce. A pilot study of 12 children treated with interferon alfa in a dosage of 3 MU/m(2) three times each week for 6 m onths showed that ALT levels normalized in approximately 90% of the pa tients after 15 months of follow-up. All of the patients had a decreas e in the histological activity of the disease. Factors predictive of a favourable response in adults were: low levels of gamma-glutamyl tran sferase, young age, female sex, short duration of disease, absence of cirrhosis and low histological activity of the disease. Controlled ran domized studies are needed to determine the indications for interferon alfa therapy in children infected with HCV. Available data suggest th at children may have a better response than adults.