TREATMENT OF HEPATITIS-B SURFACE-ANTIGEN CARRIERS IN THE EARLY-STAGE OF THE INFECTION USING RECOMBINANT ALPHA-INTERFERON WITH STEROID PRIMING

Background: Alpha-interferon has been found to inhibit hepatitis B vir us (HBV) replication in Chinese patients with chronic HBV infection al though a sustained effect was rarely achieved in those with normal pre treatment serum alanine amino transferase (ALT) levels. Prednisolone p riming has been found to be beneficial over treatment with interferon alone in these subjects. We studied the effect of steroid pre-treatmen t followed by recombinant interferon alpha-2a in the treatment of asym ptomatic HBV carriers with positive hepatitis Be antigen (HBeAg), hepa titis B viral DNA (HBV-DNA) and minimal changes in liver histology. Me thods: The treatment regimen included a 6-week prednisolone priming, a 2 week rest followed by 14 weeks of three times weekly 9 mega units o f interferon alpha-2a injection and 52 weeks of follow-up. There were seven patients in the treatment group and seven controls. Results: The mean age, pre-treatment ALT (normal in all except for one in each of the treatment and control groups), HBV-DNA levels and histological sco res were similar in the two groups. Serum HBV-DNA levels fell in six p atients during treatment and became undetectable in two of them by the end. During followup, serum HBV-DNA returned to pre-treatment levels in all patients. None of the treated patients had HBeAg sere-conversio n and none of the controls had spontaneous clearance of HBV-DNA or ser e-conversion of HBeAg. No improvement of liver histology was observed in any of the treated patients. There were only mild nu-like side-effe cts noted and interferon alpha-2a was well tolerated at the doses give n among treated patients. Conclusion: Prednisolone priming followed by interferon alpha-2a treatment has no beneficial effect on HBV carrier s in the early stages of chronic hepatitis B infection.