Tenofovir Disoproxil Fumarate Treatment for Pediatric Patients with Perinatally Acquired Chronic Hepatitis B
DOI:
https://doi.org/10.17140/GOJ-1-116Keywords:
Hepatitis B virus, Chronic hepatitis B, Tenofovir disoproxil fumarate, Perinatal transmission, PediatricsAbstract
Objectives: Infection with Hepatitis B Virus (HBV) is an important cause of chronic liver disease in children. Perinatal transmission accounts for the majority of infections. We examined the effects of Tenofovir Disoproxil Fumarate (TDF) on pediatric patients with perinatally acquired Chronic Hepatitis B (CHB).
Methods: We retrospectively analyzed the data on pediatric patients with perinatally acquired CHB treated with TDF over a 72-week period.
Results: 55 cases were analyzed of which 26 were treated. Fourteen (54%) had immune active hepatitis and 12(46%) were in the immune tolerant phase. In both groups, no difference in inflammation or fibrosis was found on baseline liver biopsy. Mean HBV DNA level at baseline was 9 log10 copies/mL. Levels declined to 5.9 log10 copies/mL at 40 weeks of therapy and were undetectable in 19/26(73%) of the patients by week 72. Alanine aminotransferase (ALT) levels normalized by 32 weeks in the immune active hepatitis group. No breakthrough elevations were seen in either group. Overall, 11(42%) and 9(35%) of the patients had Hepatitis B e anti gen (HBeAg) clearance and Hepatitis B e antibody (anti-HBe) seroconversion respectively by 72 weeks of treatment.
Conclusion: TDF is an effective therapy in pediatric patients with perinatally acquired CHB in both immune active hepatitis and immune tolerant phase patients. Response to treatment did not seem to be affected by baseline ALT levels and liver histopathology findings.
References
World Health Organization. Fact Sheet No. 204. Hepatitis B. 2013.
Tassopoulos NC, Papaevangelou GJ, Sjogren MH, Roume-liotou-Karayannis A, Gerin JL, Purcell RH. Natural history of acute hepatitis B surface antigen-positive hepatitis in Greek adults. Gastroenterology. 1987; 92: 1844-1850.
Taylor BC, Yuan JM, Shamliyan TA, Shaukat A, Kane RL, Wilt TJ. Clinical outcomes in adults with chronic hepatitis B in association with patient and viral characteristics: A system-atic review of evidence. Hepatology. 2009; 49: S85-S95. doi: 10.1002/hep.22929
Chen CJ, Yang HI, Iloeje UH, Group R-HS. Hepatitis B virus DNA levels and outcomes in chronic hepatitis B. Hepatology. 2009; 49: S72-S84. doi: 10.1002/hep.22884
Liaw YF, Sung JJ, Chow WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004; 351: 1521-1531.
Di Marco V, Marzano A, Lampertico P, et al. Clinical outcome of HBeAg-negative chronic hepatitis B in relation to virological response to lamivudine. Hepatology. 2004; 40: 883-891.
Marcellin P, Gane E, Buti M, et al. Regression of cirrhosis during treatment with tenofovir disoproxil fumarate for chronic hepatitis B: a 5-year open-label follow-up study. Lancet. 2013; 381: 468-475. doi: 10.1016/S0140-6736(12)61425-1
Murray KF, Szenborn L, Wysocki J, et al. Randomized, pla-cebo-controlled trial of tenofovir disoproxil fumarate in ado-lescents with chronic hepatitis B. Hepatology. 2012; 56: 2018- 2026.
Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol. 2007; 47: 598- 607. doi: 10.1016/j.jhep.2007.07.006
Heathcote EJ, Marcellin P, Buti M, et al. Three-year effi-cacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B. Gastroenterology. 2011; 140: 132-143. doi: 10.1053/j.gastro.2010.10.011
Gordon SC, Krastev Z, Horban A, et al. Efficacy of tenofo-vir disoproxil fumarate at 240 weeks in patients with chronic hepatitis B with high baseline viral load. Hepatology. 2013; 58: 505-513. doi: 10.1002/hep.26277
Lee MH, Yang HI, Liu J, et al. Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hep-atitis B patients: risk scores integrating host and virus profiles. Hepatology. 2013; 58: 546-554. doi: 10.1002/hep.26385
Lucifora J, Xia Y, Reisinger F, et al. Specific and nonhepato-toxic degradation of nuclear hepatitis B virus cccDNA. Science. 2014; 343: 1221-1228. doi: 10.1126/science.1243462
Chu CJ, Keeffe EB, Han SH, et al. Hepatitis B virus genotypes in the United States: results of anationwide study. Gastroenterol-ogy. 2003; 125: 444-451. doi: 10.1016/S0016-5085(03)00895-3
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