மருத்துவ ஆராய்ச்சி இதழ்

Outcome of Lamivudine Therapy in Children with Chronic Hepatitis B Virus in Children Welfare Teaching Hospital

Abstract

Rabab Farhan Thajeel Al-qaysi, Dhiaa H AL-Baldawi and Ali Kareem Saad

Background: Hepatitis B is a major cause of liver disease worldwide, can cause acute and chronic disease, ranking as a substantial cause of cirrhosis and hepatocellular carcinoma. A vaccine against hepatitis B available since 1982, Hepatitis B runs more serious in children due to its chronic behaviour in more than 85%of affected ones.

Patient and method: An observational retrospective cohort study, since 1st August/2015 to 1st February/2016. The patients were gathered from the gastroenterology and liver disease clinic/Child Welfare Teaching Hospital in Baghdad. Among 71 patients with chronic hepatitis B regularly followed up, a total of 32 patients on lamivudine therapy were selected for this study, the patients files were evaluated retrospectively and then followed up during their scheduled visits every 3-6 months. All patients underwent detailed history and physical examination, sent for full blood picture, liver function tests, viral panel and abdominal ultrasound.

Results: Mean ages of patients were 7.8 ± 3.87 years ranging from 2 to 14 years, male were predominating with 71.9:28.1 ratio. The majority of patients with leukemia 31% on chemotherapy and 38% finished chemotherapy, 9% thalassemia, 6% haemophilia and others accident 17%; viral load show significant decrement in Lamivudine receiving patients on chemotherapy with p value <0.001, While in those patients who were not on chemotherapy p value was 0.001. In Lamivudine receiving patients who were on chemotherapy (n=10): 20% and 40% patients with undetectable viral load (HBV DNA –ve) after 6 months and 1 year respectively had significant P value at border line 0.048; and 10%, 30% with seroconversion (HBeAb) after 3 months, 6 months respectively; and 80% normalization of ALT over I year period. While Lamivudine receiving patients with chronic HBV not on chemotherapy (n=22) : had undetectable viral load significant P value 0.026 over I year period; and there are only 9 of 22 had HBeAg +ve, 4 of 9 with seroconversion (HBeAb) after 6 months; while influence on ALT show 81.8% normalization over I year period.

Conclusion: Lamivudine therapy is an effective drug and had a significant effect on children with chronic hepatitis B, This effect was clear on HBV-DNA disappearance, and ALT normalization, HBeAg seroconversion, this was very clear on both groups of children immune compromised and immune competent. It is recommended for all children with chronic hepatitis B who are on chemotherapy to prevent reactivation of the virus.