CHRONIC HEPATITIS-B IN CHILDREN - NATURAL-HISTORY AND TREATMENT

Hepatitis B virus (HBV) infection in children is worldwide in distribu tion, but the features of HBV-associated liver disease differ dependin g on the route of transmission and the time of acquisition of the infe ction. The degree of liver injury varies from a mild disease to the de velopment of cirrhosis and hepatocellular carcinoma, and depends on th e replicative status of the viral genome. It is believed that the immu ne function plays a key role in the severity of HBV disease, and the i mpact of HBV mutants needs to be assessed. The goals of antiviral ther apy in children are therefore, the clearance of viremia and HBV sequen ces from infected tissues, together with an improvement in the liver d isease. Administration of 10 MU/m2 b.s. 3 times weekly over 6 months r esulted in a significantly higher clearance of viremia, with normaliza tion of ALT values and greater improvement in liver histology in treat ed than in untreated patients. Long-term follow-up of these cases reve als the presence of the viral genome in serum and liver by PCR without clearance of HBsAg. Complete eradication of HBV might need more years of evolution as for adult patients. The combination of more than one antiviral agent, as well as the potentiation of the immune system, nee ds to be assessed to improve the actual response rate obtained with in terferon-alpha.