Chronic hepatitis B virus in children in Israel: Clinical and epidemiological characteristics and response to interferon therapy

Objective: To describe the clinical and epidemiological features of hepatit is B virus infection in Israeli children, and to evaluate their response an d compliance to therapy. Methods: We retrospectively studied 51 patients (34 males, 17 females), age d 2-18 years, from several medical centers in Israel. Results: Of the 51 patients, 38 with elevated transaminase, positive hepati tis B e antigen and/or HBV DNA, and histologic evidence of liver inflammati on were treated. Interferon was administered by subcutaneous injections thr ee times a week for 3-12 months (dosage range 3-6 MU/m(2)). Only 16% were n ative Israelis, while 78% of the children were of USSR origin. A family his tory of HBV infection was recorded in 25 of the 51 patients (9 mothers, 16 fathers or siblings). Five children had a history of blood transfusion. The histological findings were normal in 3 patients, 24 had chronic persistent hepatitis, 14 had chronic active hepatitis and 24 had chronic lobular hepa titis. Five children also had anti-hepatitis D virus antibodies. Twelve of the 38 treated patients (31.5%) responded to IFN completely, with normaliza tion of the transaminase levels and disappearance of HBeAg and HBV DNA. In no Patient was there a loss of hepatitis B surface antigen. The main side e ffects of IFN were fever in 20 children, weakness in 10, headaches in 9, an d anorexia in 6; nausea, abdominal pain, and leukopenia were present in 3 c ases each. The response rate was not affected by age, country of origin, al anine/aspartate aminotransferase levels, or histological findings. However, a history of blood transfusion was a predictor of good response, 60% vs 27 % (P < 0.05). Conclusions: We found IFN to be a safe and adequate mote of treatment in ch ildren with chronic HBV infection, regardless of their liver histology and transaminase levels. Therefore, in view of the transient side effects assoc iated with this drug, we recommend considering its use in all children with chronic hepatitis B.