Hepatitis C: ¿un virus que podríamos erradicar? / Hepatitis C: Could we eradicate this virus?

La infección crónica con el virus C de la hepatitis constituye un problema de salud a nivel mundial, tanto en niños como en adultos. Su eliminación espontánea puede ocurrir durante la infancia temprana, y luego es infrecuente. Aunque la mayoría de los casos son asintomáticos en la infancia y adolescencia, al llegar a la edad adulta, los pacientes pueden evolucionar a la cirrosis y presentar complicaciones, que incluyen el carcinoma hepatocelular. Un tratamiento eficaz debe tener como meta la eliminación del virus, lo que significaría la curación de la enfermedad. Recientemente, el advenimiento de varios agentes antivirales de acción directa ha posibilitado una alta resolución de la infección, del 97-100 % de los casos. Para lograr este objetivo costo-efectivo, es fundamental la concientización de los pediatras en la detección de los pacientes infectados y su derivación al especialista hepatólogo pediatra para la implementación del tratamiento adecuado.

Chronic hepatitis C virus infection is a health problem worldwide, both in children and adults. Its spontaneous resolution may occur during early childhood, and then it becomes uncommon. Although most cases are asymptomatic during childhood and adolescence, as adults, patients may progress to cirrhosis and develop complications, including hepatocellular carcinoma. The goal of an effective treatment should be virus elimination, i.e., disease cure. Recently, the emergence of several direct-acting antivirals has enabled a high rate of infection resolution in 97-100 % of cases. To achieve this cost-effective objective, it is critical to raise awareness among pediatricians so that they can detect infected patients and refer them to a pediatric liver specialist for an adequate management.

Hepatitis C: Could we eradicate this virus? / Hepatitis C: ¿un virus que podríamos erradicar?

Chronic hepatitis C virus infection is a health problem worldwide, both in children and adults. Its spontaneous resolution may occur during early childhood, and then it becomes uncommon. Although most cases are asymptomatic during childhood and adolescence, as adults, patients may progress to cirrhosis and develop complications, including hepatocellular carcinoma. The goal of an effective treatment should be virus elimination, i.e., disease cure. Recently, the emergence of several direct-acting antivirals has enabled a high rate of infection resolution in 97-100 % of cases. To achieve this cost-effective objective, it is critical to raise awareness among pediatricians so that they can detect infected patients and refer them to a pediatric liver specialist for an adequate management.

La infección crónica con el virus C de la hepatitis constituye un problema de salud a nivel mundial, tanto en niños como en adultos. Su eliminación espontánea puede ocurrir durante la infancia temprana, y luego es infrecuente. Aunque la mayoría de los casos son asintomáticos en la infancia y adolescencia, al llegar a la edad adulta, los pacientes pueden evolucionar a la cirrosis y presentar complicaciones, que incluyen el carcinoma hepatocelular. Un tratamiento eficaz debe tener como meta la eliminación del virus, lo que significaría la curación de la enfermedad. Recientemente, el advenimiento de varios agentes antivirales de acción directa ha posibilitado una alta resolución de la infección, del 97-100 % de los casos. Para lograr este objetivo costo-efectivo, es fundamental la concientización de los pediatras en la detección de los pacientes infectados y su derivación al especialista hepatólogo pediatra para la implementación del tratamiento adecuado.

Hepatitis B crónica en pediatría: tratar o no tratar, esa es la pregunta / Chronic hepatitis B in pediatrics: To treat or not to treat, that is the question

La infección crónica con el virus B de la hepatitis es una de las enfermedades de mayor prevalencia mundial. Puede evolucionar a la cirrosis y carcinoma hepatocelular. La detección temprana, evitar la utilización de drogas intravenosas, la educación sexual y la vacunación son fundamentales para la prevención. La infección neonatal y durante el primer año de vida evoluciona hacia la cronicidad en más del 90 % de los niños. La transmisión vertical, de una madre con virus B de la hepatitis al recién nacido, es, actualmente, la forma más frecuente de infección. Su detección y la administración de inmunoglobulinas y vacuna disminuyen esta vía de infección. El tratamiento antiviral puede acelerar en dos o tres años el pasaje de la fase activa a la inactiva de la infección, sin influir en el proceso hacia la recuperación. El tratamiento oportuno de algunos casos elegidos puede evitar la progresión de la enfermedad

Chronic hepatitis B virus infection is one of the most prevalent diseases worldwide. It may progress to cirrhosis and hepatocellular carcinoma. An early detection, not using intravenous drugs, sex education, and immunization are critical for prevention. An infection in the neonatal period and in the first year of life becomes chronic in more than 90 % of children. Vertical transmission from a mother with hepatitis B virus to the newborn infant is currently the most common mode of transmission. Detection, immunoglobulin administration, and immunization help to reduce it. Antiviral therapy may accelerate the transition from the active to the inactive phase of infection by two or three years, without affecting the recovery process. A timely treatment of some selected cases may prevent hepatitis B progression.

Chronic hepatitis B in pediatrics: to treat or not to treat, that is the question. / Hepatitis B crónica en pediatría: tratar o no tratar, esa es la pregunta.

Chronic hepatitis B virus infection is one of the most prevalent diseases worldwide. It may progress to cirrhosis and hepatocellular carcinoma. An early detection, not using intravenous drugs, sex education, and immunization are critical for prevention. An infection in the neonatal period and in the first year of life becomes chronic in more than 90 % of children. Vertical transmission from a mother with hepatitis B virus to the newborn infant is currently the most common mode of transmission. Detection, immunoglobulin administration, and immunization help to reduce it. Antiviral therapy may accelerate the transition from the active to the inactive phase of infection by two or three years, without affecting the recovery process. A timely treatment of some selected cases may prevent hepatitis B progression.

La infección crónica con el virus B de la hepatitis es una de las enfermedades de mayor prevalencia mundial. Puede evolucionar a la cirrosis y carcinoma hepatocelular. La detección temprana, evitar la utilización de drogas intravenosas, la educación sexual y la vacunación son fundamentales para la prevención. La infección neonatal y durante el primer año de vida evoluciona hacia la cronicidad en más del 90 % de los niños. La transmisión vertical, de una madre con virus B de la hepatitis al recién nacido, es, actualmente, la forma más frecuente de infección. Su detección y la administración de inmunoglobulinas y vacuna disminuyen esta vía de infección. El tratamiento antiviral puede acelerar en dos o tres años el pasaje de la fase activa a la inactiva de la infección, sin influir en el proceso hacia la recuperación. El tratamiento oportuno de algunos casos elegidos puede evitar la progresión de la enfermedad.

Autoimmune Hepatitis in Children: Prednisone Plus Azathioprine Versus Cyclosporine: A Randomized Trial.

OBJECTIVE: The aim of this study was to find the outcome and adverse effects of 2 initial treatments in children with autoimmune hepatitis, prednisone (PRED) plus azathioprine (AZA) versus cyclosporine (CsA). STUDY DESIGN: Between December 2008 and February 2012, 50 consecutive patients were centrally randomized to 1 of 2 treatment arms. Group 1: PRED was indicated at a dose of 1 to 2 mg ·â€Škg ·â€Šday (up to 60 mg/day) and AZA at a dose of 1 to 2 mg ·â€Škg ·â€Šday. Group 2: CsA was administered at a dose of 4 mg ·â€Škg ·â€Šday orally divided into 2 doses. After remission, all patients were given a combination of PRED at 0.3 to 0.5 mg ·â€Škg ·â€Šday and AZA at 1 to 2 mg ·â€Škg ·â€Šday. Children presenting liver failure were placed on a triple immunosuppressive regimen if this condition persisted after 1 week of treatment, after liver function normalization they were switched back to their initial scheme. RESULTS: A total of 26 patients received PRED-AZA and 24 CsA. Both treatments showed similar initial results in effectiveness and safety, although remission was achieved earlier with PRED-AZA: 8.6 versus CsA: 13.6 weeks (P < 0.0081). All children recovered liver function in a mean time of 32 ±â€Š26 days. Cushingoid syndrome was more frequently observed with PRED-AZA (P < 0.001) and gingival hypertrophy with CsA (P < 0.001). A significant increase in body mass index was observed in all patients from initial treatment to remission, being greater with PRED-AZA. CONCLUSIONS: Similar outcomes were obtained with PRED plus AZA or CsA treatments. Either therapeutic strategy could be used according to the particular characteristics of each patient. Triple immunosuppression was beneficial in patients with liver failure at onset.

Immunosuppressive therapy allows recovery from liver failure in children with autoimmune hepatitis.

BACKGROUND & AIMS: Patients with autoimmune hepatitis (AIH) frequently have liver failure (LF) at the time of diagnosis; their response to immunosuppressive therapy has not been thoroughly analyzed. We evaluated the outcomes of children with AIH and LF who received immunosuppressive therapy and analyzed predictors of liver function recovery. METHODS: We collected data from 237 children that had AIH between September 1996 and December 2008; 50 had LF (defined as prothrombin time <50%) and had not received prior treatment. Patients were treated with either 2 mg/kg/day prednisone at doses up to 60 mg/day (n = 13) or 1 mg/kg/day prednisone at doses up to 40 mg/day plus cyclosporine at blood levels of 200 ± 50 ng/mL (n = 37). RESULTS: Of the 50 patients studied, 45 (90%) achieved prothrombin time >50% in a median time of 24 days (range of 4-257 days); 93% of these patients achieved this within the first 90 days of treatment. Two of the 45 patients who responded to immunosuppression required liver transplantation because of complications related to portal hypertension, and 3 died because of infection. Three of the 5 nonresponders received liver transplants - 1 remained on the waiting list, and the other died because of central nervous system bleeding. Infection was the only independently associated significant factor that delayed recovery from LF (odds ratio = 7.7, 95% confidence interval, 1.5-40). Each therapeutic approach had similar efficacy. CONCLUSIONS: Most pediatric patients with AIH recover after LF with immunosuppressive therapy; liver transplantation could be avoided or delayed. Infection was the most frequent cause of morbidity and mortality in these patients.

Efectos colaterales de la terapia esteroidea en un caso de hepatitis crónica activa autoinmune / Side effects of steroid therapy in autoinmune active chronic hepatitis. Report of a case

Se presenta una paciente con diagnóstico de HCAA tratada con corticoides que sufrió osteoporosis marcada de su columna vertebral. Se le administró calcio y vitamina D, con buena evolución clínico humoral raidológica densitométrica. Se plantea como otra alternativa terapéutica para contrarrestar la osteoporosis inducida por corticoides, la utilización de calcitonina intranasal y vitamina D.