Interferon-alpha treatment of children with chronic hepatitis D virus infection: The creek experience

Background/Aims: The therapeutic experience of interferon-alpha therapy aga inst hepatitis D virus infection in affected children is rather limited. Fo r this reason, we conducted a retrospective study (duration: 1991-1995) in order to evaluate the efficacy and the safety of interferon-a in children s uffering from chronic hepatitis D in Northwestern Greece. Methodology: Seven children who were found to be infected with HDV in a tot al of 324 children seropositive for hepatitis B virus infection during the 5-year period of the study were treated with interferon-alpha, 3x10(6) U/m( 2) body surface area, intramuscularly or subcutaneously, 3 times weekly for 1 year (after an informed consent obtained from their parents). Patients w ere assessed monthly by hematological serological and biochemical tests. Cl inical progress, levels of serum alanine aminotransferase, hepatitis D ribo nucleic acid (HDV-RNA) and hepatitis B deoxyribonucleic acid (HBV-DNA), ser oconversion of hepatitis B surface antigen (HBsAg) and Hepatitis Be Antigen (HBeAg) and liver histology were used as response criteria. Results: Posttreatment alanine transferase levels were significantly reduce d (P<0.05) but Immunoglobulin M and total anti-hepatitis D virus (anti-HDV) antibodies remained positive in all, while hepatitis D ribonucleic acid pe rsisted positive in 4 cases. In addition, no seroconversion of HBsAg or HBe Ag was noted and the liver histology progress was disappointing. Side effec ts including mild fever, arthralgias and malaise and reversible neutropenia and thrombocytopenia were common, but not particularly disturbing. Neverth eless, the children remained fully active on treatment, felt well and atten ded school. Initially 4 children had been below the 10th percentile for wei ght and height. All thrived during treatment and two crossed above the 10th percentile indicating height velocity and body mass index increase. Conclusions: The administration of regular interferon-alpha doses for treat ing children with chronic hepatitis D was safe as attested by the mild side effects and the objective clinical criteria regarding their growth, but re latively ineffective. Although the prevalence of hepatitis D virus infectio n is now generally decreased, this study indirectly indicates that more eff ective agents and new approaches at the molecular level of the hepatitis D virus genome are urgently warranted for its control in individuals already infected with the virus. Finally, the poor therapeutic results in the prese nt study further enhance the necessity of the expanded vaccination against Hepatitis B virus according to the World Health Organization's recommendati ons.