Resumen

PESTANA, Elena et al. Epidemiología, evolución y respuesta a tratamiento con diferentes esquemas de la hepatitis B crónica en pacientes pediátricos. Gen [online]. 2011, vol.65, n.4, pp.303-309. ISSN 0016-3503.

Introduction & Aims: Chronic hepatitis B represents a major public health problem world wide and pediatric population is not excluded from this reality. We aimed to assess the epidemiology of this disease in pediatric patients in Venezuela and the response of these patients to different treatment options available. Patients and Methods: A retrospective and multicenter study was conducted. We included all pediatric patients with chronic infection by virus B who were evaluated in different Pediatric Gastroenterology Units all over the the country. Results: Out of 15537 pediatric patients attending Pediatric Gastroenterology Units in different hospitals, 148 resulted with the diagnosis of chronic hepatitis B given by a positive and persistent Ags HBV for more than 6 months. This represented 1% of all patients evaluated. Of all 148 patients, 111 (75%) were male and 37 (25%) female, aged from 1 year up to 18 years (average 11,25 years). The follow-up period ranged from 3 months to 14 years (average 4.45 years). Most frecuent transmission of HBV infection was related to onchological pathologies in 65 patients (44%), hematologic diseases in 3 (2%), surgery 3 (2%), vertical transmission 11 (7%), horizontal transmission 4 (3%), chronic renal insufficiency 2 (1.3%), cardiopathy 1 (0.7%) and unknown cause in 59 (40%). 72 patients (49%) were considered active carriers with positives Ags HBV, Age HBV and HBV DNA. Out of these 72 patients, 44 (61%) had normal aminotranferases and 28 (39%) had high levels of aminotransferases, 34 (47%) had viral load over 20000 UI/ml and 38 (53%) viral load between 2000 and 20000 UI/ml. 55 patients underwent liver biopsy: 52 had findings of chronic HBV infection, 17 (31%) had fibrosis, 1 featured cirrhosis and 3 (2% of the total number of patients) had no liver injury by HBV. This was considered the group of inmunotolerants. 52 patients were treated. 1 patient received Lamivudine with a positive response, 12 patients received monotherapy with Pegylated Interferon (7 patients responded), 20 were treated with Lamivudine + IFNpeg (13 patients responded), 3 with Entecavir (2 supressed levels of HBV DNA), 14 received Entecavir + IFNpeg (only 3 patients have completed treatment with a positive response) and finally 2 were treated with Telbivudine and experienced a decrease in VHB viral load. Conclusion: Chronic HBV infection is more frequently associated to onchological pathologies. Only 2% of patients are inmmunotolerants. Only patients received interferon pegilated have a complete response.

Palabras clave : Hepatitis B; Pediatric Patients.