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ABSTRACT & COMMENTARY
In a summary of the available literature on the role of interferon therapy for chronic hepatitis C viral infection in childhood, Philip Rosenthal, MD, of the pediatric hepatitis program at University of California, San Francisco, makes several points that are worth noting.
While therapy for hepatitis B with interferon has become more or less accepted for patients with documented active disease, the therapy for hepatitis C has been much slower in gaining acceptance. This is because studies in adults have shown only a 50% response rate, and up to 75% of these responders relapse upon stopping of interferon. However, a paper from Naples reports that half of a small group of children with hepatitis C responded to therapy with interferon, and none of these children relapsed.1
The decision of whether to treat a child with hepatitis C with interferon is not clear-cut. Contrary to the results of the small Italian study cited above, most authorities feel that interferon treatment has little effect on the long-term course of hepatitis C. One of the difficulties has been the difficulty in determining the true effect of therapy if the elevation of transaminases are quite mild to begin with, and the only serology employed is an antibody to the hepatitis C virus that will not decrease even if the therapy was effective.
This problem remains a significant one, as there is good evidence that decades of hepatitis C infection can lead to cirrhosis, portal hypertension, liver failure, and hepatocellular carcinoma. The advent of better markers of hepatitis C, including the use of the polymerase reaction to quantitate hepatitis C RNA in the blood, may lead to more accurate ways to assess therapy. It is also possible that combinations of antiviral therapies may be more effective than interferon alone. Preliminary studies in adults suggest that the addition of ribaviran to interferon therapy improves the response of hepatitis C and seems to diminish the high relapse rate. Despite all of this, Rosenthal concludes his summary by noting: "To treat or not to treat with interferon in children with chronic hepatitis C virus infections remains a question." (Dr. Hillemeier is Professor of Pediatrics and Director, Division of Pediatric Gastroentrology, University of Michigan Medical Center, Ann Arbor, MI.)
1. Iorio C, et al. Lymphoblastoid interferon alpha treatment in chronic hepatitis. Arch Dis Child 1996;74:152-156.