"Chronic Hepatitis B and C in Children."

E.A. Roberts. The Hospital for Sick Children, and University of Toronto, Toronto, Canada.

According to an abstract presented by the author to the International Symposium on Pediatric Gastroenterology, Hepatology and Nutrition, held April 23-24, 1995, at the King Faisal Specialist Hospital and Research Center, "There are five well-characterized hepatotropic viruses in humans, and of these, three - hepatitis B, C and D viruses - are capable of causing chronic liver disease. In terms of prevalence of disease worldwide, hepatitis B and C viruses are the most important. Although both viruses may cause prolonged infection, progressive chronic liver disease and hepatocellular carcinoma, they have important dissimilarities. Certain problems relating to the natural history and optimum treatment of chronic hepatitis B and C in children remain unresolved. Hepatitis B virus is an enveloped double-stranded DNA virus. It is spread by contact with contaminated blood or body fluids, vertical, mother-to-child transmission accounts for most cases worldwide. The natural history of chronic hepatitis B consists of three broad phases: an initial phase of viral replication with little hepatic injury; a transition phase after cessation of immune tolerance notable for one of more episode of parenchymal damage; and a final phase when integration of the viral genome into hepatocellular DNA has occurred. In this later phase, the risk of developing hepatocellular carcinoma increases over time. During the early replicative phase HBeAg is positive; during the late integrated phase anti-HBe is positive and HBeAg is negative. Treatment with (alpha)-interferon, which has shown to be effective in some adults and children, aims at effecting this HBeAg seroconversion. Hepatitis C virus is a single-stranded positive sense RNA virus, responsible mainly for posttransfusion hepatitis. Vertical transmission also occurs. The natural history of chronic hepatitis C in adults is variable, but it is clear that cirrhosis frequently develops and that hepatocellular carcinoma is also associated with chronic hepatitis C. The natural history of chronic hepatitis C in children, especially after vertical transmission, remains unclear. Effective anti-viral treatment is still being devised."

Cancer Biotechnology Weekly, 06-12-1995, pp 21.

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