Interferon- alpha treatment of children and young adults with chronic hepatitis delta virus [HDV] infection

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. An observational study. Sarwar Zuberi Liver Centre [SZLC], Medical Unit IV, Civil Hospital, Karachi / Dow University of Health Sciences [DUHS], from June 2009 to July 2010. 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/m2/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. 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. Conventional INF- 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

Treatment profile of hepatitis C patients - a comparison of interferon alpha 2a and 2b treatment regimes

To compare the side effects, cost, end treatment response [ETR] and Sustained viral response [SVR] with combination therapy of either interferon alpha 2a or 2b in combination with Ribavarin. Randomized Control Clinical Trial [RCCT]. The study was conducted at Sarwar Zuberi Liver Centre [SZLC], Civil Hospital Karachi [CHK], from May 2004 to July 2009. Patients positive for qualitative HCV ribonucleic acid [RNA] by Polymerase chain reaction [PCA] and genotype 3 were included. Patients with decompensated cirrhosis, severe depressive illness, autoimmune hepatitis, hyperthyroidism, pregnancy, heart failure, uncontrolled diabetes, obstructive pulmonary disease, children less than three years and patients who had previously received treatment were excluded. Single blind randomization using computerized randomization list was done and patients divided into groups A and B, those requiring treatment were given injection Interferon 3 million units [MU] subcutaneously [SC] three times/week and Ribavarin 1000 mg per day [weight 75kg] orally with either interferon alpha 2a [group A; FDA approved products] or alpha 2b [group B; non FDA approved product]. Demographics, side effects, ETR and SVR were noted. ETR was defined as absence of virus at the end of treatment and SVR was taken as absence of HCV RNA at 6 months after completion of treatment. There were a total 310 patients with mean age of 34.07 +/- 9.38 years including 52.4% males, [n=162]. Majority of the patients were from North Pakistan. There were 155 patients each in group A and group B respectively. The cost of treatment for interferon alpha for a single patient for 6 months was Rs 60,000, while for Interferon alpha 2b was Rs 30,000. Side effects [fever initially, followed by fatigue, headache, musculoskeletal pain, depression, alopecia, insomnia, and anorexia] were more prominent in group B when compared with group A. In group A, ETR was 83.8% [130/155] while in group B was 83.2% [129/155]. While SVR available in group A was 61/70 [87.1%] and in group B was 60/72 [83.3%]. Response to combination therapy for HCV was 83%. ETR and SVR were similar for both interferon alpha 2a and 2b. Side effects though minor are more with alpha 2b [non FDA approved products]