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      Hepatitis B y C en pacientes oncológicos

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          Abstract

          La mayoría de los niños que padecen enfermedades hemato-oncológicas reciben múltiples transfusiones y esto aumenta el riesgo para adquirir estas infecciones. Por otro lado, en estos niños inmunosuprimidos la infección suele ser subclínica. Suele diagnosticarse al observar elevación de aminotransferasas. Objetivo: evaluar la respuesta al tratamiento de hepatitis en niños con antecedentes oncológicos. Materiales: 80 pacientes con antecedentes de tratamiento hematoncológico, del año 2000 a 2008 con serologías positivas para hepatitis viral. Resultados: 39 (48,75%) presentan Hepatitis B, 19 (23,75%) Hepatitis C, 22 (27,75%) coinfección Hepatitis B y C. En el grupo HBV, 7 negativizaron espontáneamente DNAHBV. 20 recibieron tratamiento con diferentes esquemas: 3 IFN, 4 lamivudina, 3 lamivudina + IFN, 10 Lamivudina + PEG; 7/20 negativizaron ADN VHB. 6/10 con tratamiento combinado negativizaron DNAHBV (60%). En el grupo con Hepatitis C, todos genotipo 1; 3 negativizaron RNAHCV espontáneamente; 10 recibieron tratamiento, 3/10 tratados con IFN + RIBAVIRINA y 7 con PEG + RIBAVIRINA. 1/3 y 4/7 (57,14%), negativizaron RNAHCV, respectivamente. En el grupo con coinfección, 14 tratados: 2 IFN; 4 IFN + RIBAVIRINA; 8 PEG + RIBAVIRINA. 11/12 con esquema combinado culminaron tratamiento; negativizaron 1/11 (9%) DNAHBV y 5/11 (45,45%) RNAHCV. 8/80 desarrollaron complicaciones, cirrosis y hepatocarcinoma. Conclusión: los pacientes pediátricos presentan respuesta al tratamiento para hepatitis B y C crónicas, similar al del adulto. Hubo diferencia estadísticamente significativa en la respuesta al tratamiento relacionado con el grado de inflamación en pacientes coinfectados. Cirrosis y hepatocarcinoma también se presentan en este grupo de edad.

          Translated abstract

          Most children with hemato-oncological diseases receive multiple transfusions, and this increases the risk of acquiring these infections. On the other hand, in these immunosuppressed children the infection is usually subclinical. It’s usually diagnosed by observing an elevation in aminotransferases fi gures. Objective: To evaluate the response to the treatment for hepatitis in children with a history of cancer. Materials: 80 patients with a history of hemato-oncological treatment, from 2000 to 2008, with positive viral hepatitis serologies/for viral hepatitis. Results: 39 (48,75 %) had Hepatitis B, 19 (23,75 %) Hepatitis C, 22 (27,75 %) coinfection Hepatitis B and C. In the HBV group, 7 had spontaneous HBV-DNA negative, 20 received treatment with different schemes: 3 IFN, 4 lamivudine, 3 lamivudine + IFN, 10 lamivudine + PEG; 7/20 had HBV-DNA negative. 6/10 with combined treatment had HBV-DNA negative (60%). In the group with Hepatitis C, all genotype 1; 3 had spontaneous HCV-RNA negative; 10 received treatment, of which 3/10 were treated with IFN + RIBAVIRIN and 7 with PEG + RIBAVIRIN. 1/3 and 4/7 (57.14 %) had HCV-RNA negative, respectively. In the group with HBV/HCV co-infection, 14 patients treated: 2 IFN, 4 IFN + RIBAVIRIN, 8 PEG + RIBAVIRIN. 11/12 with combined scheme ended treatment; 1/11 (9 %) and 5/11 (45,45 %) had HBV-DNA and HCV-RNA negative, respectively. 8/80 developed complications, such as, cirrhosis and hepatocellular carcinoma. Conclusion: pediatric patients presented similar response to adult patients, to the treatment for chronic hepatitis B and C. There was a statistically significant difference in treatment response related to the degree of inflammation in coinfected patients. Cirrhosis and hepatocellular carcinoma are also evidenced in this age group.

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          Most cited references35

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          Hepatocellular carcinoma in 2 young adolescents with chronic hepatitis C.

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            Combined lamivudine/interferon-alpha treatment in "immunotolerant" children perinatally infected with hepatitis B: a pilot study.

            To investigate whether combining the antiviral effect of lamivudine with the immune-boosting action of interferon-alpha (IFN-alpha) is effective in treating hepatitis B virus (HBV) "immunotolerant" children.
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              Chronic hepatitis C virus infection after treatment for pediatric malignancy.

              Sera of 658 patients who had completed treatment for pediatric malignancy were analyzed by a second-generation enzyme-linked immunosorbent assay and recombinant immunoblot assay test to assess the prevalence of hepatitis C virus (HCV)-seropositivity. All HCV-seropositive patients underwent detailed clinical, laboratory, virologic, and histologic study to analyze the course of HCV infection. One hundred seventeen of the 658 patients (17.8%) were positive for HCV infection markers. Among the 117 anti-HCV+ patients, 41 (35%) were also positive for markers of hepatitis B virus infection with or without delta virus infection markers, 91 (77.8%) had previously received blood product transfusions, and 25 (21.4%) showed a normal alanine aminotransferase (ALT) level during the last 5-year follow-up (11 of them never had abnormal ALT levels). The remaining 92 patients showed ALT levels higher than the upper limit of normal range. Eighty-one of 117 (70%) anti-HCV+ patients were HCV-RNA+, with genotype 1b being present in most patients (54%). In univariate analysis, no risk factor for chronic liver disease was statistically significant. In this study, the prevalence of HCV infection was high in patients who were treated for a childhood malignancy. In about 20% of anti-HCV+ patients, routes other than blood transfusions are to be considered in the epidemiology of HCV infection. After a 14-year median follow-up, chronic liver disease of anti-HCV+ positive patients did not show progression to liver failure.
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                Author and article information

                Contributors
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                June 2010
                : 64
                : 2
                : 86-92
                Affiliations
                [1 ] Hospital de Niños J.M de los Ríos Venezuela
                Article
                S0016-35032010000200005
                d7545362-41d3-4239-bf3b-6c748486a77f

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                hepatitis B,hepatitis C,coinfection,children,treatment,oncological,coinfección,niños,tratamiento,oncológico

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