Hepatitis C And Hepatitis D Virus

Hepatitis D Virus

It is a faulty virus since it depends on concurrent HBV infection because its outer coat is made of HBsAg. It is a tiny RNA virus that belongs to the delta family. It occurs less frequently in kids. Co-infection and superinfection are the two modes of transmission. In superinfection, HDV takes two to eight weeks to incubate; in co-infection, IP is equivalent to HBV's.

An HDV infection eventually overlays an HBV infection at first. Severe hepatotoxic alterations are caused by HDV. Sexual contact and parenteral/blood products are the mechanisms of transmission.

Clinical Features Of HDV Infection 

Although severe, the clinical symptoms resemble those of other hepatotropic viruses. When co-infected with HBV, HDV causes a serious but self-limiting illness with a low chance of becoming chronic.
There is a substantial risk of both acute and chronic liver failure in superinfection. There is a substantial risk of ALF in superinfection.

Diagnostic Findings Of HDV Infection

IgM anti-HDV: Appearance occurs roughly 2-4 weeks following co-infection and roughly 10 weeks following superinfection.

Also Read: Hepatitis A Virus : Characteristics, Clinical Features

Treatment And Prevention Of HDV Infection

The therapeutic approach for HDV is managing HBV rather than using specific therapy. HDV infection is indirectly prevented by HBV immunization.

Hepatitis C Virus                    

It is a single-stranded RNA virus that is part of the flavivirus family. Out of the six genotypes of HCV, genotype 1b is the most prevalent in the West and is the least responsive to the pediatric drugs that are authorized. In India, genotype 3 is the most common.

Of infants born to viremic moms, 5% of transmission occurs during pregnancy. Sexual interaction and the use of parenteral or blood products are among the other factors.  There is an incubation period of 30 to 150 days. Hepatic steatosis and lymphoid clusters or follicles in the portal tracts are caused by this slightly cytopathic condition.

Also Read:  Viral Hepatitis In Children

Clinical Features HCV Infection

It is associated with acute to mild infection and carries a significant risk of chronicity. It is common for HCV to cause hepatic fibrosis.
Vasculitis is frequently linked to it, particularly essential mixed cryoglobulinemia.  Late-onset porphyria cutanea.   Within 20–30 years of an acute infection, about 25% of individuals get cirrhosis, liver failure, and primary HCC.

Diagnosis Of Hcv Infection

The diagnostic techniques for HCV detection include HCV RNA detection and antibody testing. RNA detection is more costly but more sensitive than an antibody test. Testing using antibodies , o identify IgM anti-HCV, a third-generation immunoassay is employed. In a high-risk group, it provides good predictive values; in a low-risk population, false positivity occurs in 50–60% of instances. False-negative results occur when antibodies test negative up to three months after the illness's clinical start.

Anti-HCV antibodies do not offer immunity or protection. HCV-RNA identification  It may be qualitative or quantitative in nature.
  Throughout the infection, AST and ALT levels change, and they are not correlated with liver fibrosis.

Also Read: Pediatric TB - Guidelines, Diagnosis And Management

Assessment Of Hepatic Fibrosis

Liver biopsy is an antiquated technique used to rule out illnesses similar to one another and in situations when a diagnosis cannot be made. Magnetic resonance elastography is the chosen method of inquiry.

Complication In Chronic HCV

 Persistent HCV infection Of all the types, HCV has the highest likelihood of becoming chronic. Hepatic fibrosis, cirrhosis, and HCC may result from it. Old age, obesity, moderate alcohol consumption, and male gender are risk factors for the development of fibrosis.  Severe liver failure In cases of HCV infection, it is possible but uncommon.

Natural History 

Less than 1% of individuals have fatal fulminant hepatic failure. Alternatively, liver transplantation may be able to save the patients.
  Without any help, 20–40% of patients heal on their own.  Between 60 and 80 percent of patients have ongoing infections. Some people have high ALT/AST levels and grow cirrhosis as they age. Twenty percent of those with chronic hepatitis go on to develop cirrhosis.  Approximately 4% of cirrhosis patients experience fatal HCC.

HCV Treatment               

Sustained viral response, which is the absence of viremia following medication discontinuation, is the aim of treatment.  Treatment outcome is influenced by the HCV genotype. While genotypes 2 and 3 respond well, genotype 1 responds poorly.  In certain kids, the infection may go away on its own.

Children over the age of three can purchase drugs. They are: Pegylated interferon; IFN-alpha2b; Ribavirin; and IFN monotherapy, which even for genotype 1 exhibits higher SVR in children than in adults, up to 49%.
  Patients under the age of twelve exhibit improved response to genotypes 2 and 3, as well as genotype 1b with low viral load. Less than 2 million copies of RNA per milliliter of blood.

Also Read: Rapid Acquisition Of Key Concepts Infections

Treatment Regimens In Children

The most popular treatment plan consists of 24-48 weeks of pegylated IFN and ribavirin combination therapy.  NEWER DRUG REGIMENS: Therapy should be discontinued after 24 weeks if viral PCR results remain positive.

The FDA has approved sofosbuvir for use in conjunction with ledipasvir or as a standalone medication in children ages 12 to 17. It works well against genotypes 1, 4, 5, and 6. It also works well against genotypes 2 and 3, when combined with ribavirin. Both treatment regimens are utilized in children who have minimal or no cirrhosis.

Prevention And Prognosis

There is currently no HCV vaccine available.  Superinfection is avoided by vaccination against HAV and HBV. Individuals who have been exposed to HCV need to take certain precautions.  Viral titers every year to look for spontaneous remission.  Annual screening for hepatocarcinoma with AFP and ultrasonography  Giving up alcohol and consuming large amounts of fat.

Hope you found this blog helpful for your NEET SS Pediatrics Infections preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.