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Chronic viral hepatitis in childhood
1Clinica Medica II, University of Padova, Italy.
Insights
Hepatitis B virus (HBV) infection in children can lead to chronic liver disease, with outcomes varying based on infection timing. Interferon therapy shows promise in improving outcomes for Caucasian children with HBV.
Area of Science:
- Pediatric Hepatology
- Viral Hepatitis Research
- Childhood Infectious Diseases
Background:
- Hepatitis B virus (HBV) is a significant cause of chronic liver disease in children, particularly in endemic regions.
- Perinatal HBV infection often leads to persistent viral replication, while later infections are more likely to resolve spontaneously.
- Hepatitis delta and Hepatitis C are other viral hepatitis forms seen in children, each with distinct clinical courses and treatment responses.
Purpose of the Study:
- To review the epidemiology, clinical manifestations, and management of viral hepatitis in childhood.
- To highlight the long-term implications of chronic HBV infection, including cirrhosis and hepatocellular carcinoma risk.
- To evaluate the efficacy of Interferon (IFN) therapy in pediatric viral hepatitis.
Main Methods:
- Review of existing literature on pediatric viral hepatitis (HBV, Hepatitis delta, HCV).
- Analysis of disease progression, complications, and treatment outcomes in children.
- Comparison of spontaneous remission rates versus IFN treatment efficacy.
Main Results:
- Children with perinatal HBV infection often maintain viral replication, whereas most infected later in life achieve remission.
- Cirrhosis is an uncommon but serious early complication of chronic HBV in children.
- IFN therapy can accelerate HBV DNA clearance and improve anti-HBe seroconversion in Caucasian children, but has limited efficacy for Hepatitis delta.
Conclusions:
- Outcomes for childhood viral hepatitis vary, with HBV requiring long-term monitoring due to potential late reactivation.
- Hepatitis delta presents severe challenges in childhood, with poor response to IFN.
- Hepatitis C in children is typically mild but rarely resolves spontaneously, prompting evaluation of IFN treatment.
Abstract:
In endemic areas infection with hepatitis B virus is a common cause of chronic liver disease in childhood. High levels of viral replication and mild ALT abnormalities are the rule in children infected perinatally and many of them are likely to maintain viral replication through their youth. Conversely about 90% of children infected later in life clear HBeAg and achieve sustained remission of liver disease before reaching adulthood. The eventual outcome of infection and disease in these patients remains unpredictable as reactivation of liver damage and viral replication may occur after several years of sustained remission. Cirrhosis is a rare and early complication of chronic HBV infection in children, and a risk factor for hepatocellular carcinoma. IFN therapy can accelerate HBV DNA clearance, improving the spontaneous anti-HBe seroconversion rate in Caucasian children by two to three times. Hepatitis delta is the most severe form of chronic viral hepatitis in childhood. Cirrhosis can be diagnosed in up to 26% of patients at presentation, and few cases respond to IFN therapy. Hepatitis C is relatively rare in children. Before the discovery of HCV, blood transfusions were the most common source of infection. Hepatitis C is usually a mild, asymptomatic disease in otherwise healthy children, but has a poor propensity to spontaneous remission over the years. For this reason, and based on the experience in adults, IFN treatment is now being evaluated.