Evaluation of the natural prognosis and treatment results of the disease in pediatric patients with the diagnosis of chronic hepatitis B between 2008-2018

Objective: Chronic Hepatitis B infection is observed in a wide spectrum ranging from asymptomatic disease in childhood to fulminant Hepatitis even cirrhosis and hepatocellular cancer in adolescence. In this study, we aimed to evaluate the demographic, epidemiological, clinical and laboratory results of pediatric patients followed up with the diagnosis of Chronic Hepatitis B infection, to evaluate the results of treatment in patients who were started on treatment, and to determine the factors that affect the response to treatment. Material and Method: In this study, pediatric patients aged 0-18 years with a diagnosis of Chronic Hepatitis B infection followed for at least 5 years in Çukurova University Medical Faculty Balcalı Hospital Pediatric Infectious Diseases polyclinic between January 1, 2008 and December 31, 2018 were retrospectively analyzed. The data were obtained from the hospital information system and patient files. Statistical evaluation was made in the Department of Biostatistics of CUTF, and a p value of <0.05 was accepted as significant in the data analysis. Results: The mean age at diagnosis of 121 patients examined in our study was 8.7 years. Fifty-three patients (43.8%) were female and 68 patients (56.2%) were male. 64.5% of the patients were diagnosed during the family screening process. The presence of Hepatitis B infection in the family is 81%. The most common mode of transmission of the disease is vertical transmission with 59.5%, and horizontal transmission with 19.8%, second. The mean follow-up period of the patients in our study was 101.2 months, and the maximum follow-up period was 194 months. Of the 121 pediatric patients followed, 42 (34.7%) developed spontaneous seroconversion. In patients who developed spontaneous seroconversion, ALT values at diagnosis were statistically significantly higher (p=0.023), and HBV DNA levels were statistically significantly lower (p=0.001) compared to the group that did not develop spontaneous seroconversion. In addition, HAV IgG positivity at diagnosis (83.3%) was statistically significantly higher in the group that developed spontaneous seroconversion (p=0.015). When a total of 16 patients who developed HBsAg/AntiHBs seroconversion with spontaneous (n=6) and treatment (n=10) and 105 patients who did not develop seroconversion were compared in terms of demographic, clinical and laboratory characteristics, it was found that the group that developed HBsAg/Anti-HBs seroconversion was statistically significant older at diagnosis (p=0.017). All patients who developed HBsAg/AntiHBs seroconversion also developed HBeAg/AntiHBe seroconversion. In our study, a total of 72 (59.5%) patients were started on CHB treatment. As initial treatment, 37 patients received IFN, 27 patients IFN+LAM, 7 patients Lamivudine and 1 patient Adefovir treatment. In 36 of these patients, sequential treatment was continued. The response rate to treatment (partial response and/or complete response) was 55%. The patient group receiving IFN monotherapy (n=37) and the patient group receiving combined treatment (IFN+LAM) (n=27) were evaluated in terms of their response to treatment 6 months after the end of the treatment. The seroconversion response to treatment was proportionally higher in IFN monotherapy (43%) compared to IFN+LAM combined treatment (29%), but there was no statistically significant difference (p=0,225) Conclusion: In this study, 42 (34,7%) of the 121 patients we followed up with chronic Hepatitis B infection developed spontaneous HBeAg/Anti-HBe seroconversion, and CHB treatment was started in 72 patients. Thirty (41.6%) of the patients who started treatment gave partial response to the treatment (biochemical + serological response), 10 (13,8%) gave a complete response (biochemical + serological + virological response). Patients who responded to treatment had significantly higher ALT values and HBV DNA levels at diagnosis. The seroconversion rate in IFN monotherapy was proportionally higher than in combined therapy, but this difference was not statistically significant (p=0,225). The gradual decrease in pediatric patients with CHB who applied to our clinic after 2010, once again reveals the importance of national Hepatitis B immunization and Hepatitis B screening during pregnancy. Key Words: Interferon, Combined therapy, Chronic Hepatitis B infection, Lamivudine, Spontaneous seroconversion,