Combined lamivudine/interferon-α treatment in 'immunotolerant' children perinatally infected with hepatitis B:: A pilot study
Combined lamivudine/interferon-α treatment in 'immunotolerant' children perinatally infected with hepatitis B:: A pilot study
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DOI：
10.1016/j.jpeds.2005.09.020
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发表时间：
2006-02-01
影响因子：
5.1
通讯作者：
Mieli-Vergani, G
中科院分区：
文献类型：
--
作者：
D'Antiga, L;Aw, M;Mieli-Vergani, G
目的 探讨拉米夫定的抗病毒作用与干扰素-α (IFN-α) 的免疫增强作用相结合是否能有效治疗乙型肝炎病毒 (HBV)“免疫耐受”儿童。 研究设计 23 名儿童（8 名男孩；平均年龄为 10 岁）在出生后第一年感染（17 名亚洲人，21 名转氨酶水平正常，15 名 HBV-DNA > 1000 pg/mL）单独使用拉米夫定（3 mg/kg）治疗 8 周，然后联合使用拉米夫定（3 mg/kg）和 IFN-α（5 MU/m(2)，每周 3 次）治疗 10 个月。 结果 78% 的患者在治疗结束时 HBV-DNA 转为阴性，5 例（22%）血清转化为抗 HBe，4 例（17%）血清转化为抗 HBe。他们实现了病毒的完全控制，HBsAg 持续阴性，抗 HBs 阳性。没有人患有 YMDD 突变。中位随访 40 个月（范围为 36 至 48 个月）后，患者的病毒状态并未发生变化。 结论 这项初步研究表明，拉米夫定预处理后联合拉米夫定和 IFN-α 可以诱导 HBV 免疫耐受儿童（迄今为止被认为反应较差的儿童）的病毒完全控制。
Objective To investigate whether combining the antiviral effect of lamivudine with the immune-boosting action of interferon-alpha (IFN-alpha) is effective in treating hepatitis B virus (HBV) "immunotolerant" children.Study design Twenty-three children (8 boys; mean age, 10 years) infected during the first year of fife (17 Asian, 21 with normal aminotransferase levels, 15 with HBV-DNA > 1000 pg/mL by hybridization and all with mild histologic changes) were treated with lamivudine (3 mg/kg) for 8 weeks alone and their lamivudine (3 mg/kg) and IFN-alpha (5 MU/m(2), 3 times weekly) in combination for 10 months.Results Seventy-eight percent became HBV-DNA negative at the end of treatment, 5 (22%) seroconverted to anti-HBe, 4 (17%) of whom achieved complete viral control, becoming persistently HBsAg negative and anti-HBs positive. None had YMDD mutations. The viral status of the patients has not changed after a median follow-up of 40 months (range, 36 to 48).Conclusions This pilot study suggests that lamivudine pretreatment followed by a combination of lamivudine and IFN-alpha can induce complete viral control in HBV immunotolerant children, hitherto considered poor responders.