Interferon-α treatment in children and young adults with chronic hepatitis B: A long-term follow-up study in Taiwan

Background/Aims: The short- and long-term benefits of interferon (IFN)-α therapy in young patients with chronic hepatitis B (CHB) acquiring infection perinatally or during early childhood have been questioned. Methods: Twenty-one Taiwanese hepatitis B envelope antigen (HBeAg)-positive CHB patients aged 1.8-21.8 years (median 14.0 years) with alanine aminotransferase (ALT) >80IU/L at entry were enrolled for IFN-α therapy. They received IFN-α therapy with a dose of 3MU/m2/day three times a week for 24 weeks. A control group included untreated 21 CHB patients closely matched for gender, age, duration of ALT >80IU/L and HBeAg status. All 42 patients were prospectively followed for 6.5-12.5 years after the end of therapy. Results: The cumulative rate of virological response [anti-HBe seroconversion and serum hepatitis B virus (HBV)-DNA <10 5 copies/ml] was not different between the IFN-treated patients and control patients at 1 year (41 vs 44%) and at 6 years (88 vs 89%) after stopping treatment. Serum hepatitis B surface antigen loss occurred in two (9.5%) treated patients and in one (4.8%) control patient. Patients with a successful treatment response (anti-HBe seroconversion, HBV-DNA <10 2 copies/ml and ALT normalization at 1 year after stopping treatment) were younger than those without a successful response (P = 0.03). A lower pretreatment serum HBV-DNA level (<2 × 10 8 copies/ml) is not only a significant factor to predict successful treatment response (P = 0.008) but also has a beneficial effect on the long-term cumulative rate of virological response in IFN-treated patients (P = 0.021), but not in control patients. Genotype difference or emergence of a precore stop codon mutant before treatment was not predictive for HBeAg clearance. Conclusion: For young CHB patients in Taiwan with infection occurring perinatally or in early childhood, the real advantage of IFN-α therapy was not observed. IFN-α therapy showed a beneficial effect on short- and long-term virological outcomes only in those with a lower pretreatment serum HBV-DNA level. ? Journal compilation ? 2008 Blackwell Munksgaard.