Clinical presentation of hepatitis D in Pakistani children

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. Materials and 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. Conclusion: Children with HDV infection have more aggressive liver disease than HBV monoinfection irrespective of HBeAg status.