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.