Interferon-Alpha Treatment of Children and Young Adults with Chronic Hepatitis Delta Virus (HDV) Infection

Objective: To determine the response of one-year interferon-alpha therapy in hepatitis delta virus (HDV) infection in children and young adults at a tertiary care hospital, Karachi, Pakistan. Study Design: An observational study. Place and Duration of Study: Sarwar Zuberi Liver Centre (SZLC), Medical Unit IV, Civil Hospital, Karachi / Dow University of Health Sciences (DUHS), from June 2009 to July 2010. Methodology: Paediatric patients (< 18 years age) and young adults (18-35 years) presenting were screened for hepatitis B virus (HBV) and HDV sero-markers. HDV anti-body positive by ELISA were further screened for hepatitis D ribonucleic acid (HDV-RNA) by real time PCR. HDV RNA PCR positive patients were treated with INF-alpha (children 6 MIU/m(2)/day and adults 5 MIU/day) for a period of one year. Patients were assessed monthly. Haematological parameters and ALT were monitored during treatment. Clinical progress (side effects) and negative HDV RNA were used as response criteria. Results: Overall 49 patients were HDV RNA positive (children: n = 15, mean age 15 +/- 2.92 years adults: n = 34, mean age 27 +/- 4 years). Eighty percent were male. Treatment was given to 25 patients (children: n = 11, adults: n = 14). HBV genotype D was the predominant in all HDV RNA positive patients (73%). Eighty percent (20/25) were HDV-RNA negative after one year of treatment, and remaining patients are still under treatment. Side effects were tolerated well and children continued regular activity. Haematological parameters were unremarkable. Children maintained their pre-treatment centile for height and weight (growth parameters). ALT levels were significantly decreased post-treatment. Conclusion: Conventional INF-alpha was safe in children with HDV infection in terms of side effects and growth parameters. Eighty percent were HDV-RNA negative one year after treatment. Further follow-up 2 years post-treatment will give conclusive results.