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Objective:To investigate whether combining the antiviral effect of lamivudine with the immune-boosting action of interferon-alpha(IFN-α)is effective in treating hepatitis B virus(HBV)“immunotolerant”children.Study design:Twen tythree children(8 boys;mean age,10 years)infected during the first year of life(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 l amivudine(3 mg/kg)for 8 weeks alone and then lamivudine(3 mg/kg)-and IFN-α(5 MU/m2,3 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 persis tently 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 pretrea tment followed by a combination of lamivudine and IFN-αcan induce complete vir al control in HBV immunotolerant children,hitherto considered poor responders.
Objective: To investigate whether combining the antiviral effect of lamivudine with the immune-boosting action of interferon-alpha (IFN-α) is effective inolving hepatitis B virus (HBV) “immunotolerant” children. Study design: Twen tythree children ; mean age, 10 years) infected during the first year of life (17 Asian, 21 with normal aminotransferase levels, 15 with HBV-DNA> 1000 pg / mL by hybridization and all with mild histologic changes) mg / kg for 8 weeks alone and then lamivudine (3 mg / kg) -and IFN-α (5 MU / m2, 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, is persisntlyntly infected with 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 pretrea tmen t followed by a combination of lamivudine and IFN-acan induce complete vir al control in HBV immunotolerant children, hitherto considered poor responders.