923. High Prevalence of HBV-DNA in Children with Chronic Hepatitis B after Seroconversion to Anti-Hbe

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20Progression.htm#Nov2a923

923. High Prevalence of HBV-DNA in Children with Chronic Hepatitis B after

Seroconversion to Anti-Hbe

S. Gehring; T. Gumbrich; F. Zepp; U. Kullmer

Introduction & Aim:

The goal of therapy for chronic hepatitis B virus (HBV) infection in children is

to eliminate HBV replication and prevent the progression of liver disease to

cirrhosis. Interferon-alpha (IFN-á) and Lamivudine (LMV) have been approved for

treatment in children, Adefovir is currently investigated in a multi-centre

trial. In western countries, treatment with IFN-á has been found to lead in up

to 58% of children to the loss of HBV-DNA and HBe antigen (Ag) seroconversion.

After the introduction of a highly sensitive HBV-DNA real-time PCR system at our

institution the overall prevalence of HBV-DNA in our pediatric population was

re-evaluated.

Methods:

Forty pediatric patients ages 4 - 22 years (average 13,4) were evaluated. 24/40

children underwent a treatment with IFN-á. 8/40 children received treatment with

LMV. Patients were monitored with liver function tests (LFT), complete blood

cell count, auto-antibody screening (LKM, ANA, SMA), thyroid screening,

hepatitis screens (HBe, HBs, anti-HBe, anti-HBs, anti-HBc), and HBV DNA by

quantitative PCR at each visit. Quantitative real-time PCR for HBV-DNA was

performed with the commercially available COBASR test system.

Results:

Eighty percent of the children in our study group were infected by neonatal

transmission. Ethnic background included 23 South/Eastern-European (Poland,

Russia, Albania, and Turkey), 3 Asian, and 14 German children. 9/24 children

(37%) that received IFN-á converted HBeAg negative and developed HBe antibodies.

Only one child receiving LMV treatment became HBeAg negative during therapy. All

children had copies> 2 million/ml prior to therapy. 10/40 children (25%)

developed spontaneously HBe antibodies and converted HBeAg negative. Development

of anti-HBe in association with treatment or spontaneously led to a significant

reduction of LFT levels and a drop of HBV-DNA from a median of 447 million

copies/ml to 2100 copies/ml. Importantly, only 2 out of 20 anti-HBe positive

children developed HBV-DNA levels below detection level (< 100 copies/ml).

Conclusions:

Key elements of a successful treatment in HBV infected individuals (sustained

response) are seroconversion from HBeAg to anti-HBe and / or loss of HBV-DNA.

With the introduction of a highly sensitive quantitative HBV-DNA PCR testing

system, we observed that the vast majority (90%) of our seroconverted children

remained to be at a low level HBV-DNA positive. Subsequently, the risk of

infectivity after seroconversion appears to be diminished but not eliminated,

which remains to be a challenging burden particularly during adolescence.

[Guest guest]

http://www.hbvadvocate.org/news/reports/HBV_AASLD_2008/Abstracts/Nov2%20Disease%\

20Progression.htm#Nov2a923

923. High Prevalence of HBV-DNA in Children with Chronic Hepatitis B after

Seroconversion to Anti-Hbe

S. Gehring; T. Gumbrich; F. Zepp; U. Kullmer

Introduction & Aim:

The goal of therapy for chronic hepatitis B virus (HBV) infection in children is

to eliminate HBV replication and prevent the progression of liver disease to

cirrhosis. Interferon-alpha (IFN-á) and Lamivudine (LMV) have been approved for

treatment in children, Adefovir is currently investigated in a multi-centre

trial. In western countries, treatment with IFN-á has been found to lead in up

to 58% of children to the loss of HBV-DNA and HBe antigen (Ag) seroconversion.

After the introduction of a highly sensitive HBV-DNA real-time PCR system at our

institution the overall prevalence of HBV-DNA in our pediatric population was

re-evaluated.

Methods:

Forty pediatric patients ages 4 - 22 years (average 13,4) were evaluated. 24/40

children underwent a treatment with IFN-á. 8/40 children received treatment with

LMV. Patients were monitored with liver function tests (LFT), complete blood

cell count, auto-antibody screening (LKM, ANA, SMA), thyroid screening,

hepatitis screens (HBe, HBs, anti-HBe, anti-HBs, anti-HBc), and HBV DNA by

quantitative PCR at each visit. Quantitative real-time PCR for HBV-DNA was

performed with the commercially available COBASR test system.

Results:

Eighty percent of the children in our study group were infected by neonatal

transmission. Ethnic background included 23 South/Eastern-European (Poland,

Russia, Albania, and Turkey), 3 Asian, and 14 German children. 9/24 children

(37%) that received IFN-á converted HBeAg negative and developed HBe antibodies.

Only one child receiving LMV treatment became HBeAg negative during therapy. All

children had copies> 2 million/ml prior to therapy. 10/40 children (25%)

developed spontaneously HBe antibodies and converted HBeAg negative. Development

of anti-HBe in association with treatment or spontaneously led to a significant

reduction of LFT levels and a drop of HBV-DNA from a median of 447 million

copies/ml to 2100 copies/ml. Importantly, only 2 out of 20 anti-HBe positive

children developed HBV-DNA levels below detection level (< 100 copies/ml).

Conclusions:

Key elements of a successful treatment in HBV infected individuals (sustained

response) are seroconversion from HBeAg to anti-HBe and / or loss of HBV-DNA.

With the introduction of a highly sensitive quantitative HBV-DNA PCR testing

system, we observed that the vast majority (90%) of our seroconverted children

remained to be at a low level HBV-DNA positive. Subsequently, the risk of

infectivity after seroconversion appears to be diminished but not eliminated,

which remains to be a challenging burden particularly during adolescence.

[Guest guest]

http://www.hbvadvocate.org/news/reports/HBV_AASLD_2008/Abstracts/Nov2%20Disease%\

20Progression.htm#Nov2a923

923. High Prevalence of HBV-DNA in Children with Chronic Hepatitis B after

Seroconversion to Anti-Hbe

S. Gehring; T. Gumbrich; F. Zepp; U. Kullmer

Introduction & Aim:

The goal of therapy for chronic hepatitis B virus (HBV) infection in children is

to eliminate HBV replication and prevent the progression of liver disease to

cirrhosis. Interferon-alpha (IFN-á) and Lamivudine (LMV) have been approved for

treatment in children, Adefovir is currently investigated in a multi-centre

trial. In western countries, treatment with IFN-á has been found to lead in up

to 58% of children to the loss of HBV-DNA and HBe antigen (Ag) seroconversion.

After the introduction of a highly sensitive HBV-DNA real-time PCR system at our

institution the overall prevalence of HBV-DNA in our pediatric population was

re-evaluated.

Methods:

Forty pediatric patients ages 4 - 22 years (average 13,4) were evaluated. 24/40

children underwent a treatment with IFN-á. 8/40 children received treatment with

LMV. Patients were monitored with liver function tests (LFT), complete blood

cell count, auto-antibody screening (LKM, ANA, SMA), thyroid screening,

hepatitis screens (HBe, HBs, anti-HBe, anti-HBs, anti-HBc), and HBV DNA by

quantitative PCR at each visit. Quantitative real-time PCR for HBV-DNA was

performed with the commercially available COBASR test system.

Results:

Eighty percent of the children in our study group were infected by neonatal

transmission. Ethnic background included 23 South/Eastern-European (Poland,

Russia, Albania, and Turkey), 3 Asian, and 14 German children. 9/24 children

(37%) that received IFN-á converted HBeAg negative and developed HBe antibodies.

Only one child receiving LMV treatment became HBeAg negative during therapy. All

children had copies> 2 million/ml prior to therapy. 10/40 children (25%)

developed spontaneously HBe antibodies and converted HBeAg negative. Development

of anti-HBe in association with treatment or spontaneously led to a significant

reduction of LFT levels and a drop of HBV-DNA from a median of 447 million

copies/ml to 2100 copies/ml. Importantly, only 2 out of 20 anti-HBe positive

children developed HBV-DNA levels below detection level (< 100 copies/ml).

Conclusions:

Key elements of a successful treatment in HBV infected individuals (sustained

response) are seroconversion from HBeAg to anti-HBe and / or loss of HBV-DNA.

With the introduction of a highly sensitive quantitative HBV-DNA PCR testing

system, we observed that the vast majority (90%) of our seroconverted children

remained to be at a low level HBV-DNA positive. Subsequently, the risk of

infectivity after seroconversion appears to be diminished but not eliminated,

which remains to be a challenging burden particularly during adolescence.

[Guest guest]

http://www.hbvadvocate.org/news/reports/HBV_AASLD_2008/Abstracts/Nov2%20Disease%\

20Progression.htm#Nov2a923

923. High Prevalence of HBV-DNA in Children with Chronic Hepatitis B after

Seroconversion to Anti-Hbe

S. Gehring; T. Gumbrich; F. Zepp; U. Kullmer

Introduction & Aim:

The goal of therapy for chronic hepatitis B virus (HBV) infection in children is

to eliminate HBV replication and prevent the progression of liver disease to

cirrhosis. Interferon-alpha (IFN-á) and Lamivudine (LMV) have been approved for

treatment in children, Adefovir is currently investigated in a multi-centre

trial. In western countries, treatment with IFN-á has been found to lead in up

to 58% of children to the loss of HBV-DNA and HBe antigen (Ag) seroconversion.

After the introduction of a highly sensitive HBV-DNA real-time PCR system at our

institution the overall prevalence of HBV-DNA in our pediatric population was

re-evaluated.

Methods:

Forty pediatric patients ages 4 - 22 years (average 13,4) were evaluated. 24/40

children underwent a treatment with IFN-á. 8/40 children received treatment with

LMV. Patients were monitored with liver function tests (LFT), complete blood

cell count, auto-antibody screening (LKM, ANA, SMA), thyroid screening,

hepatitis screens (HBe, HBs, anti-HBe, anti-HBs, anti-HBc), and HBV DNA by

quantitative PCR at each visit. Quantitative real-time PCR for HBV-DNA was

performed with the commercially available COBASR test system.

Results:

Eighty percent of the children in our study group were infected by neonatal

transmission. Ethnic background included 23 South/Eastern-European (Poland,

Russia, Albania, and Turkey), 3 Asian, and 14 German children. 9/24 children

(37%) that received IFN-á converted HBeAg negative and developed HBe antibodies.

Only one child receiving LMV treatment became HBeAg negative during therapy. All

children had copies> 2 million/ml prior to therapy. 10/40 children (25%)

developed spontaneously HBe antibodies and converted HBeAg negative. Development

of anti-HBe in association with treatment or spontaneously led to a significant

reduction of LFT levels and a drop of HBV-DNA from a median of 447 million

copies/ml to 2100 copies/ml. Importantly, only 2 out of 20 anti-HBe positive

children developed HBV-DNA levels below detection level (< 100 copies/ml).

Conclusions:

Key elements of a successful treatment in HBV infected individuals (sustained

response) are seroconversion from HBeAg to anti-HBe and / or loss of HBV-DNA.

With the introduction of a highly sensitive quantitative HBV-DNA PCR testing

system, we observed that the vast majority (90%) of our seroconverted children

remained to be at a low level HBV-DNA positive. Subsequently, the risk of

infectivity after seroconversion appears to be diminished but not eliminated,

which remains to be a challenging burden particularly during adolescence.