title: Clinical presentation of hepatitis D in Pakistani children.
abstract: BACKGROUND
  There are limited data on hepatitis D in children. The aim of this study was to assess the clinical presentation of hepatitis D virus (HDV) infection in Pakistani children.
  
  
  METHODS
  All pediatric patients (age≤18 years) seen in the clinic with chronic HDV infection and detectable HDV RNA (n=48) were compared with consecutive hepatitis B virus (HBV) monoinfection patients (n=48). A total of 50 patients underwent liver biopsy: 28 in the HDV group and 22 in the HBV group.
  
  
  RESULTS
  There was a male preponderance (85.4%). Significant differences were noted in age (P=0.012), presence of cirrhosis (P=0.004), splenomegaly (P<0.001), esophageal varices (P=0.006), splenic varices (P=0.022), alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transferase levels (P<0.001 each), platelet count (P=0.015), international normalized ratio (P<0.001), severity of inflammation on liver biopsy (P=0.007), and advanced fibrosis (P=0.016) in the two groups, indicating more severe disease in the HDV group. In the HDV group, six patients had normal ALT, of whom three were positive for hepatitis B e antigen (HBeAg) and HBV DNA. HBV DNA was detectable in 50% and HBeAg in 52% of the HDV patients. There were no differences in the severity of liver disease in HBeAg-reactive and HBeAg-nonreactive patients. Six patients with hepatitis D had decompensation at the time of presentation; five were HBV DNA positive and three had reactive HBeAg. Only one patient with HBV monoinfection had decompensation.
  
  
  CONCLUSIONS
  Children with HDV infection have more aggressive liver disease than HBV monoinfection irrespective of HBeAg status.
authors.affiliation: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.forename: Ghous B
authors.initials: GB
authors.lastname: Soomro
authors.forename: Syed M
authors.initials: SM
authors.lastname: Hassan
authors.forename: Nasir H
authors.initials: NH
authors.lastname: Luck
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D019701:Hepatitis D, Chronic / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D003698:Hepatitis Delta Virus / Q000235:genetics; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D012720:Severity of Illness Index; D015163:Superinfection; D013997:Time Factors; D019562:Viral Load
chemical_list: D015415:Biomarkers; D006513:Hepatitis B e Antigens; D012367:RNA, Viral