101
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Abstract
PURPOSE OF REVIEW Hepatitis C virus infection has recently been recognized as a viral infection with the potential to cause significant complications, including cirrhosis and hepatocellular carcinoma in adults. Changes in our understanding of its natural history in children and recent advances in therapy for acute and chronic hepatitis C are reviewed. RECENT FINDINGS Recent work has demonstrated that, although uncommon, vertical transmission is the most frequent mode of hepatitis C acquisition in children and is enhanced in the setting of maternal co-infection with HIV. Chronic hepatitis C during childhood leads in some cases to development of advanced hepatic fibrosis, with complications including liver failure and liver cancer, which has changed our general approach to this infection. Perhaps the most significant recent advance in this area is our improved understanding of the safety and efficacy of interferon-based antiviral therapies for children with hepatitis C. SUMMARY Hepatitis C virus infection has reached epidemic proportions worldwide; despite its being less prevalent in children than in adults, it poses a significant clinical problem in this age group. Emerging antiviral therapies are currently in clinical trials for adult patients with hepatitis C with encouraging preliminary results, which should be extended to children.
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Affiliation(s)
- Nizar N Zein
- Department of Gastroenterology and Hepatology, the Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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102
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Kowala-Piaskowska A, Mozer-Lisewska I, Figlerowicz M, Słuzewski W. Adverse effects during the treatment with pegylated interferon and ribavirin in children with chronic hepatitis C. Pharmacoepidemiol Drug Saf 2007; 16:1095-103. [PMID: 17724740 DOI: 10.1002/pds.1458] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
PURPOSE Administration of pegylated interferon-alpha (IFN-alpha) and ribavirin in adults with chronic hepatitis C (CHC) is a recommended therapeutic standard. Nevertheless, this therapeutic regimen rises numerous controversies. The aim of this study was to analyze adverse effects during the treatment with pegylated IFN-alpha and ribavirin in children with CHC. METHODS Study group comprised 30 children with CHC, age 8-19 years (mean 13,6 years), 9 girls and 21 boys. All patients were administered two medication therapy with pegylated IFN-alpha-2b in the dose of 1.5 microg/kg of body weight 1x/week subcutaneously and daily oral ribavirin 15 mg/kg of bodyweight for 48 weeks. Blood samples were taken at baseline and every 4 weeks during the whole treatment and 24 weeks of follow-up period. Panel of test included: cellular blood count and smear, ALT activity, bilirubin level. Patients complaints were noticed during every visit. Thyroid hormones and antibodies were checked every 3 months. Children were divided into group A that responded to treatment and group B-nonresponders. RESULTS Abnormalities in laboratory tests (white blood cells, neutrophils, haemoglobin) were observed mainly during first weeks of treatment. Mean bilirubin level and platelets were normal. Mean ALT normalized during the treatment. After 12-16 weeks of the therapy somatic adverse effects decreased significantly. CONCLUSIONS Administration of pegylated IFN-alpha and ribavirin in children with CHC is related to characteristic adverse effects. Periodical dose reduction was necessary. Although side effects and subjective patient complaints were present, children attended school without difficulties. Constant monitoring is required during the whole treatment.
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Affiliation(s)
- Arleta Kowala-Piaskowska
- Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
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103
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Heller S, Valencia-Mayoral P. Treatment of Viral Hepatitis in Children. Arch Med Res 2007; 38:702-10. [PMID: 17613361 DOI: 10.1016/j.arcmed.2006.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 09/13/2006] [Indexed: 12/22/2022]
Abstract
Hepatitis B and hepatitis C are important causes of chronic liver disease in children and adolescents, and later on for potential cirrhosis and primary hepatocellular carcinoma. The risk of developing chronic hepatitis B (HB) infection ranges from 90% in neonates to <5% in adults. Hepatitis C induces chronic infection in at least 85% of affected persons. HBV and HCV associated liver damage appears to be less severe in children than in adults. At the present time, lamivudine and a combination of interferon and lamivudine seem to be the best options for HB infection treatment in the pediatric population, even though they induce the presence of drug-resistant mutations, and new therapies have to be developed to improve reduction and cessation of viral replication and decrease the emergence of mutations. Therapy with interferon and ribavirin seems to offer the best results for children and adolescents. Results from a study on pegylated interferon in a pediatric population might lead to better therapeutic responses. Cost of treatment for chronic viral hepatitis is very high and efforts have to continue to extend hepatitis B vaccination to the general population worldwide to reduce vertical and horizontal transmission of hepatitis C.
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Affiliation(s)
- Solange Heller
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
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104
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Abstract
The prevalence of chronic hepatitis C infection in the general paediatric population varies between 0.1 and 15% around the world, with the highest numbers noted in endemic areas of Africa. The risk of viral transmission from an infected mother to her child is approximately 5% and there are currently no effective preventative measures to lower it. All children born to infected mothers should be tested for hepatitis C. The progression to liver damage in infected children is slow. However, in the perspective of 15-20 years of infection or in the presence of other risk factors, such as concomitant chronic disease, a progression to more severe liver damage can be seen. Thus, the use of antiviral treatment may be of importance. Treatment combinations of interferon and ribavirin seem to be at least as effective in children as in adults. However, the negative effect on growth of interferon requires specific attention by paediatricians.
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Affiliation(s)
- Björn Fischler
- Department of Pediatrics, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
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105
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McCaughan GW, Omata M, Amarapurkar D, Bowden S, Chow WC, Chutaputti A, Dore G, Gane E, Guan R, Hamid SS, Hardikar W, Hui CK, Jafri W, Jia JD, Lai MY, Wei L, Leung N, Piratvisuth T, Sarin S, Sollano J, Tateishi R. Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection. J Gastroenterol Hepatol 2007; 22:615-33. [PMID: 17444847 DOI: 10.1111/j.1440-1746.2007.04883.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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106
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Baker RD, Dee D, Baker SS. Response to pegylated interferon alpha-2b and ribavirin in children with chronic hepatitis C. J Clin Gastroenterol 2007; 41:111-4. [PMID: 17198073 DOI: 10.1097/mcg.0b013e31802dd2f6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
GOALS The purpose of this communication is to report our observations on the treatment of a diverse group of adolescent patients who were chronically infected with hepatitis C and received pegylated interferon and ribavirin. BACKGROUND The currently accepted optimal therapy for adults with chronic hepatitis C is weekly injections of pegylated interferon and twice daily oral ribavirin. Information on interferon alone or in combination with ribavirin for chronic hepatitis C in children is limited. There is no published information on pegylated interferon and ribavirin in pediatric patients who previously failed interferon therapy. REPORT Ten patients 11 to 18 years old received weekly pegylated interferon and twice daily ribavirin for hepatitis C. Treatment continued for 48 weeks, except for 1 patient with hepatitis C virus type 3a who was treated for 24 weeks and 1 patient who did not complete the course of treatment. The period of observation continued from November 2002 to December 2004. Within this group were 3 pediatric patients who had previously failed interferon therapy for hepatitis C. RESULTS All but 1 patient had a viral response (no detectable virus) at some time during or after the treatment. Three patients achieved sustained viral response (no detectable virus 6 mo after the therapy). One patient who previously failed interferon therapy was among the sustained responders. CONCLUSIONS In response to treatment with pegylated interferon and ribavirin, children and adolescents with chronic hepatitis C achieve results similar to those seen in adults. Previous antiviral therapy does not preclude positive response to pegylated interferon and ribavirin.
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Affiliation(s)
- Robert D Baker
- Women and Children's Hospital of Buffalo, University at Buffalo, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY 14222, USA.
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107
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Affiliation(s)
- Jay H Hoofnagle
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.
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108
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Shneider BL, González-Peralta R, Roberts EA. Controversies in the management of pediatric liver disease: Hepatitis B, C and NAFLD: Summary of a single topic conference. Hepatology 2006; 44:1344-54. [PMID: 17058223 DOI: 10.1002/hep.21373] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Benjamin L Shneider
- Division of Pediatric Hepatology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA.
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109
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Gehring S, Kullmer U, Koeppelmann S, Gerner P, Wintermeyer P, Wirth S. Prevalence of autoantibodies and the risk of autoimmune thyroid disease in children with chronic hepatitis C virus infection treated with interferon-alpha. World J Gastroenterol 2006; 12:5787-92. [PMID: 17007043 PMCID: PMC4100658 DOI: 10.3748/wjg.v12.i36.5787] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 08/05/2006] [Accepted: 08/14/2006] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the prevalence of autoantibodies in chronic hepatitis C virus (HCV)-infected children focusing on thyroid autoimmunity. METHODS We investigated the prevalence of auto-antibodies in 123 chronic HCV-infected children before, during and after monotherapy with interferon-alpha (IFN-alpha) or combined treatment with interferon-alpha or peginterferon-alpha and ribavirin. Besides antibodies against smooth muscle (SMA), nuclei (ANA), and liver/kidney microsomes (LKM), the incidence of anti-thyroid peroxidase antibodies as well as thyroid function parameters (TSH, FT3 and FT4) were determined. RESULTS We found that 8% of children had autoantibodies before treatment. During treatment, 18% of children were found positive for at least one autoantibody; 15.5% of children developed pathologic thyroid values during IFN-alpha treatment compared to only one child before therapy. Six children had to be substituted while developing laboratory signs of hypothyroidism. CONCLUSION Our data indicate a strong correlation between interferon-alpha treatment and autoimmune phenomena, notably the emergence of thyroid antibodies. The fact that some children required hormone replacement underlines the need of close monitoring in particularly those who respond to therapy and have to be treated for more than 6 mo.
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Affiliation(s)
- Stephan Gehring
- Children's Hospital, HELIOS Klinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, D-42283 Wuppertal, Germany
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110
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Abstract
Hepatitis C virus (HCV) infection in children is becoming an increasing challenge to health professionals. As our understanding of the disease evolves, so must our diagnostic and management strategies. In the 1990s, when HCV testing became available, children identified with HCV infection in the UK were mostly those who had required blood products, particularly those with haematological disorders. Acquiring knowledge of the natural history of HCV infection was confounded by the co-morbidity of iron overload, viral co-infection, and chemotherapy.
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Affiliation(s)
- S M Davison
- Children's Liver and GI Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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111
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Affiliation(s)
- Deirdre Kelly
- The Liver Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
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112
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Rumbo C, Fawaz RL, Emre SH, Suchy FJ, Kerkar N, Morotti RA, Shneider BL. Hepatitis C in children: a quaternary referral center perspective. J Pediatr Gastroenterol Nutr 2006; 43:209-16. [PMID: 16877987 DOI: 10.1097/01.mpg.0000228117.52229.32] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic hepatitis C virus (HCV) infection affects 0.3% of children in the United States, and the general impression is that it has a benign course in childhood. We analyzed a pediatric population with chronic HCV in a quaternary referral center. MATERIAL AND METHODS This is a retrospective clinical review comprising all patients with chronic HCV referred to the Pediatric Liver/Liver Transplant Program between January 1999 and December 2004. RESULTS Ninety-one patients (52% female; mean age, 9 years) were assessed. Eight-three percent of the patients were genotype 1. Twenty-one patients received/are receiving interferon and ribavirin for chronic HCV (treatment indications--advanced disease, 9; clinical trial, 6; genotype 2, 2; social, 2; prerenal transplant, 1). Eight (53%) of 15 patients, who have completed therapy and follow-up, achieved sustained viral response. Seven of 91 patients had cirrhosis at presentation (mean age, 11.7 years). Four underwent liver transplantation, all experienced HCV recurrence, 2 died, 1 was retransplanted, and 1 has compensated cirrhosis. CONCLUSION Although, in general, HCV in children has a slow progression, there are cases with an accelerated course and early development of cirrhosis requiring liver transplant. Hepatitis C virus recurs universally after transplant, and its prognosis is usually poor; therefore, the most promising long-term approach is to clear this infection before transplantation.
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Affiliation(s)
- Carolina Rumbo
- Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA
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113
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Abstract
PURPOSE OF REVIEW This review aims to provide a concise summary of relevant developments in the treatment and prevention of viral hepatitis based on publications between December 2004 and November 2005. RECENT FINDINGS Long-term therapy with lamivudine was shown to reduce the incidence of adverse clinical outcomes in patients with chronic hepatitis B. This benefit was, however, diminished in patients with viral breakthrough. Combination therapy (peginterferon or telbivudine plus lamivudine) decreased the risk of antiviral resistance but did not improve response compared with monotherapy. Entecavir and tenofovir were shown to be effective in suppressing lamivudine-resistant hepatitis B. A shorter duration of peginterferon-ribavirin treatment was shown to be feasible in genotype 2/3 hepatitis C patients. Relapsers to previous standard interferon-based therapy had higher sustained virological response rates than previous non-responders when retreated with peginterferon-ribavirin. Hepatitis C patients with advanced liver disease may achieve sustained virological response with peginterferon-ribavirin treatment, but the complication rate was high. SUMMARY New insights into the management of viral hepatitis have been gained over the past year. The problem of antiviral resistance in chronic hepatitis B is real and treatment options need to keep evolving. Advances have been made in hepatitis C treatment including patients with genotypes 2 or 3 infection and decompensated cirrhosis.
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Affiliation(s)
- Stephen N Wong
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, 48109, USA
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114
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Elisofon SA, Jonas MM. Hepatitis B and C in children: current treatment and future strategies. Clin Liver Dis 2006; 10:133-48, vii. [PMID: 16376798 DOI: 10.1016/j.cld.2005.10.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A large proportion of chronic hepatitis B virus (HBV) infections are acquired during childhood. Fewer chronic hepatitis C virus (HCV) infections occur in children than in adults, but thousands of children worldwide have this serious infection. Optimal treatment strategies for these chronic infections in children have not been determined, because data on the natural history are limited. Few medications are currently approved for use in this population. This article discusses how chronic viral hepatitis differs in children and adults in epidemiology, natural history, progression of disease, and response to treatment. Treatment options are discussed, including patient selection, specific medications, ongoing studies, and future treatment options.
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Affiliation(s)
- Scott A Elisofon
- Division of Gastroenterology, Children's Hospital Boston, Hunnewell Ground, 300 Longwood Avenue, Boston, MA 02115, USA
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115
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England K, Thorne C, Newell ML. Vertically acquired paediatric coinfection with HIV and hepatitis C virus. THE LANCET. INFECTIOUS DISEASES 2006; 6:83-90. [PMID: 16439328 DOI: 10.1016/s1473-3099(06)70381-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Both HIV and hepatitis C virus (HCV) can be transmitted from mother to child during pregnancy and delivery. Vertical transmission of HIV and HCV separately is most likely from HIV/HCV-coinfected mothers; however, transmission of both infections is less frequent. The effect of HCV coinfection on HIV-related disease remains unclear; whereas most studies indicate no effect, recent results suggest HCV in adults accelerates HIV progression. Little is known about how HIV coinfection affects HCV progression in children and the information available is based on small numbers of patients. Paediatric HIV treatment is extremely successful and it is vital to determine if HCV coinfection alters the effectiveness of this treatment. The hepatotoxicity of many HIV therapies and the possible negative impact of HCV on this treatment, alongside the interactions and contraindications of many HIV and HCV therapies, further limits the choice of paediatric treatments for coinfected children. Future research must therefore focus on vertically acquired HIV/HCV coinfection to inform treatment trials addressing coinfection management.
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Affiliation(s)
- Kirsty England
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK
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