Nutritional status of children with chronic hepatitis B in a population with low socioeconomic status.

OBJECTIVE: Chronic infections and liver diseases may lead to malnutrition. However, growth failure is rarely reported in chronic hepatitis B. We aimed to establish the nutritional status of children with chronic hepatitis B and the relation between anthropometric data and laboratory findings in a population with low socioeconomic status. METHODS: Anthropometrical and laboratory findings were noted from the hospital records. Cases with and without malnutrition were compared with regard to sex, age, histological activity (HAI) scores, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, protein, albumin, and hepatitis B virus (HBV) DNA levels. RESULTS: Eighty children, of which 36 (45%) were girls, with a mean age of 11.5+/-3.2 years were enrolled in the study. Malnutrition was found in 39 (49%). Acute malnutrition (24 out of 39, 61.5%) was the most common form. There was no difference of age or sex between children with and without malnutrition. Age of diagnosis was higher and duration of follow-up was shorter in cases with malnutrition (P = 0.051 and P = 0.016, respectively). In children with malnutrition, aspartate aminotransferase levels were significantly higher but other laboratory results were not different. Malnutrition rate was not different between groups that did and did not receive treatment or that did and did not respond to treatment. Anthropometrical data and malnutrition rate was similar in children with high and low HAI scores. CONCLUSION: As features suggesting severe liver disease like high alanine aminotransferase values, HAI scores, or HBV DNA levels were not different in children with and without malnutrition, it may be proposed that chronic HBV infection does not have an effect on nutritional status.

Fulminant amoebiasis in a child with recurrent multiple amoebic liver abscesses and pleuropulmonary complications.

A 5-year-old boy with recurrent liver abscesses and pleural empyema, presumed to be amoebic, is described. Despite surgical drainage of the liver and thoracic wall combined with metronidazole and chloroquine, he died 7 weeks after admission.

Comparison of antiviral effect of lamivudine with interferon-alpha2a versus -alpha2b in children with chronic hepatitis B infection.

AIM: To compare additive efficacy of combination therapy including interferon (IFN)-alpha2a+lamivudine (3TC) to IFN-alpha2b+3TC in children with chronic hepatitis B virus (HBV) infection. MATERIAL AND METHODS: Chronic hepatitis B infection was determined by presence of HBsAg, HBeAg and HBV DNA in serum screened at 3 months intervals for at least 1 year, serum alanine transaminase (ALT) levels more than 1.5-times the upper normal limit and chronic hepatitis with histological activity index (HAI) more than 6 by liver biopsy. Sixty-three children with chronic hepatitis B infection were treated randomly with thrice-weekly subcutaneous injections of 5 MU/m2 recombinant IFN-alpha2a (n=29) or recombinant IFN-alpha2b (n=34) with the same dose, intervals for 6 months. Patients also received 3TC (4 mg/kg/day, max 100 mg/day) orally daily combined with IFN and continued for 12 months. End of therapy response was defined as ALT normalization, HBV DNA clearance and HBe/anti-HBe seroconversion. Breakthrough infection was determined as re-emergence of HBV DNA in serum after its clearance. Response rate, incidence of side effects and breakthrough infection were compared between IFN-alpha2a+3TC- and IFN-alpha2b+3TC-treated patients. RESULTS: Response rate was 44.8% (n=13) with IFN-alpha2a+3TC and 47.1% (n=16) with IFN-alpha2b+3TC (P=1.0). No significant difference was found in respect to the DNA clearance (P=0.32), anti-HBe (P=1.0), anti-HBs (P=0.09) seroconversion and response rates (P=1.0) between the groups. Breakthrough infection was detected in 1 (3.4%) case on IFN-alpha2a and none of the cases on IFN-alpha2b (P=0.46). All of the patients experienced flu-like symptoms, malaise and fatigue; however, side effect interfering with therapy was not encountered. CONCLUSION: No significant difference was found in response rates achieved by combination therapies based on IFN-alpha2a and IFN-alpha2b. Clinical efficacy of 3TC and two different IFN subtypes was found similar.

Current therapeutic approaches in childhood chronic hepatitis B infection: a multicenter study.

BACKGROUND AND AIM: The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. METHODS: A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-alpha 2b (10 MU/m2) thrice/weekly alone for 6 months. In the second (n = 60) and third groups (n = 60), IFN-alpha was used for 6 months (5 MU/m2) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. RESULTS: The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 +/- 93 IU/L, 101 +/- 64 IU/L and 92 +/- 42 IU/L, respectively (P > 0.05). At the end of the therapy, ALT values decreased to 82 +/- 111 IU/L, 38 +/- 41 IU/L and 29 +/- 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups (P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar (P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups (P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). CONCLUSIONS: Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-alpha monotherapy group, no significant difference was found in the complete response ratios of all three groups.