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Long-term interferon-alpha treatment of children with chronic hepatitis delta: a multicentre study
V Di Marco1, R Giacchino, A Timitilli
1Istituto di Medicina Generale, University of Palermo, Italy.
Insights
Prolonged interferon-alpha (IFN) therapy for chronic hepatitis delta virus (HDV) in children showed transient biochemical and virological responses. Long-term treatment did not significantly improve outcomes compared to medium-term therapy.
Area of Science:
- Hepatology
- Virology
- Pediatric Gastroenterology
Background:
- Chronic hepatitis delta virus (HDV) infection is a significant cause of liver disease in children.
- Interferon-alpha (IFN) therapy is a potential treatment, but its efficacy in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of prolonged interferon-alpha 2b therapy in children with chronic HDV hepatitis.
- To compare the outcomes of medium-term (12 months) versus long-term (24 months) IFN-alpha treatment.
Main Methods:
- A total of 26 pediatric patients with chronic HDV hepatitis were treated with IFN-alpha 2b.
- Patients were divided into a medium-term group (MTG) and a long-term group (LTG).
- Biochemical (ALT normalization), virological (HBeAg, HBV DNA, HDV RNA, HDVAg), and histological parameters were assessed.
Main Results:
- Complete biochemical response (normal ALT) was observed in 12 children (46%).
- Relapses occurred in 10 children (38%) after therapy cessation.
- HBeAg and HBV DNA loss were noted in some patients, but HBeAg reappeared in two.
- HDV RNA persisted in 3/10 MTG patients after 12 months and was positive in 8/10 one year after stopping therapy.
- No significant histological improvements were observed in either group.
Conclusions:
- Interferon-alpha treatment for chronic HDV hepatitis in children yields a transient effect.
- Prolonged therapy (24 months) did not demonstrate superior therapeutic benefit over medium-term treatment (12 months).
- Further research into more effective and sustained treatments for pediatric HDV infection is warranted.
Abstract:
We assessed the efficacy of prolonged interferon-alpha (IFN) therapy in children with chronic hepatitis caused by hepatitis delta virus (HDV) by treating 26 paediatric cases with IFN-alpha 2b (5 MU m-2, then 3 MU m-2 three times weekly for 12 (medium-term group MTG) or 24 months (long-term group, LTG). Compliance and tolerability were acceptable. At the end of therapy a complete biochemical response [normalization of alanine aminotransferase (ALT)] occurred in 12 children (5/13 in MTG and 7/13 in LTG). A relapse occurred after stopping IFN in 10 cases (five in MTG and five in LTG). Two patients from the LTG had normal liver function tests during 12 months of follow-up. Six of the eight hepatitis B e antigen (HBeAg) positive children lost HBeAg, while all six hepatitis B virus (HBV) DNA positive patients lost HBV DNA during treatment. HBeAg reappeared later in two children. HDV RNA, present in 10/10 cases of MTG before treatment, persisted after 12 months IFN therapy in 3/10. One year after stopping therapy, 8/10 patients were again HDV RNA positive. Two children cleared hepatitis delta antigen (HDVAg) from the liver. No significant improvements in liver histology were seen in both groups. Our experience suggests that IFN-alpha treatment in children with chronic type D hepatitis has a transient effect, and long-term treatment does not appear to induce a greater therapeutic benefit in terms of biochemical and virological response.