To date, relatively little research has been
done on children with chronic hepatitis C, although some reports suggest that
liver disease tends to be mild compared with hepatitis C in adults. Two studies
on the natural history of HCV infection in children were presented at the American
Association for the Study of Liver Diseases (AASLD) annual meeting last month
in Boston. Study 1
The Peds-C Trial was designed to assess
the efficacy and safety of pegylated
interferon alfa-2a (Pegasys), with or without ribavirin, in children with
chronic hepatitis C. As part of the trial, researchers examined liver biopsies
from 101 HCV-infected children. Participants had HCV viremia for at least 6 months,
did not have hepatic decompensation, and were previously treatment-naive.
Liver
biopsies were performed at study entry if not obtained within the previous
36 months. Biopsies were scored for inflammation and fibrosis based on the Knodell
and Ishak systems. Steatosis was scored as 0 (none), 1+ (< 5% of tissue showing
fat accumulation), 2+ (6%-33%), or 3+ (> 33%).
Results
60% of subjects
were male, ages ranged from 3.3 to 16.7 years (mean 10.4), and body mass index
(BMI) ranged from 12.1 to 32.4 (mean 20.5).
80% had perinatally acquired HCV and 81% had genotype 1.
Only 4 children had bridging fibrosis and 2 had cirrhosis (6% total).
Steatosis
was absent in 56% of patients, minimal (1+) in 34%, and mild (2+) in 10%.
There was a weak correlation between inflammation score and serum ALT level (P
= 0.03), but no significant correlation with age, BMI, or HCV genotype.
Fibrosis scores (Knodell and Ishak) correlated with inflammation scores (P <
0.0001), but not with age, genotype, BMI, or steatosis.
Steatosis correlated only with ALT (P = 0.0021) and BMI (P = 0.0002).
-
The mean BMI for children with no steatosis was 19.1, compared with 20.8 for those
with 1+ steatosis and 26.6 for those with 2+ steatosis.
Conclusion In
comparison with these results, the researchers noted that in 3 cohorts comprising
3559 treatment-naive adult patients, the mean Knodell score was 7.4 and 24% had
bridging fibrosis or cirrhosis.
"In this cohort of U.S. children recruited
for the Peds-C Trial, inflammation, fibrosis, and steatosis were milder than reported
for treatment-naive adults with chronic hepatitis C," the authors concluded.
"Inflammation correlated weakly with fibrosis and serum ALT. Hepatic steatosis
was mild but correlated weakly with BMI and serum ALT."
Study 2
The
second study looked at the impact of HCV infection on quality of life and emotional
and cognitive outcomes in children. While HCV infection is associated with decreased
quality of life and neurocognitive dysfunction in adults, little is known about
its impact on children and their caregivers.
Researchers assessed quality
of life and behavioral, emotional, and cognitive functioning of 84 HCV positive
children enrolled in the Peds-C Trial, as well as quality of life of the children's
primary caregivers.
At time of enrollment, children underwent a baseline
assessment that included the Child Health Questionnaire (CHQ), Child Behavior
Checklist (CBCL), Child Depression Inventory (CDI), and Behavior Rating Inventory
of Executive Function (BRIEF). Primary caregivers completed the SF-36. Results
54% of the children were male, 77% were white, and the mean age was 10.6 years.
80% were
infected with HCV via perinatal transmission, 83% had genotype 1, the median duration
of infection was 31.6 months, and the median ALT level was 50 IU/L.
82% of the caregivers were women, 81% were white, and the mean age was 44.8 yrs
(range 27-66).
There were no significant differences between the study sample and published normative
data with regards to:
- CHQ (physical summary: 51.6 ± 6.2 vs 53.0
± 8.8; psychosocial summary: 50.7 ± 9.4 vs 51.2 ± 9.1);
-
CBCL (internalizing: 51.9 ± 9.8 vs 50.0 ± 10.0; externalizing: 49.5
± 10.2 vs 50.0 ± 10.0; total behavior problem: 50.5 ± 10.6
vs 50.0 ± 10.0);
- BRIEF (behavioral regulation index: 52.5 ±
10.7 vs 50.0 ± 10.0; metacognition index: 54.2 ± 12.2 vs 50.0 ±
10.0; global executive composite: 54.0 ± 11.9 vs 50.0 ± 10.0).
Only 1 child had a depression (CDI) score within the clinical range.
Age and disease indices (genotype, ALT) were not significantly associated with
CHQ summary scores.
For the caregivers, there were no significant differences in SF-36 scores.
Conclusion
In conclusion, the researchers wrote, "HCV infection, in its early
stages, does not lead to impairment in quality of life, emotional, behavioral,
or cognitive functioning for infected children or in quality of life of their
caregivers."
Armed Forces Institute of Pathology, Washington, DC;
Maryland Medical Research Institute, Baltimore, MD; Children's Hospital Medical
Center, Cincinnati, OH; University of Florida, Gainesville, FL; Children's Hospital
of Philadelphia, Philadelphia, PA; Children's Hospital, Boston, MA; George Washington
University, Washington, DC; Indiana University, Indianapolis, IN; Children's Hospital
and Regional Medical Center, Seattle, WA; Children's Hospital, Denver, CO; University
of California, San Francisco, CA; Columbia University Medical Center, New York,
NY; Johns Hopkins University, Baltimore, MD. Harvard Medical School, Boston, MA;
University of Cincinnati, Cincinnati, OH; University of Pennsylvania, Philadelphia,
PA; George Washington University, Washington, DC; Indiana University, Indianapolis,
IN; University of Washington, Seattle, WA; University of Colorado, Denver, CO;
University of California, San Francisco, CA; Columbia University, New York, NY;
Johns Hopkins University, Baltimore, MD; University of Florida, Gainesville, FL.
11/17/06
References
Z
Goodman, H Makhlouf, L Liu, and others. Pathology of Chronic Hepatitis C in Children:
Liver biopsy findings in the Peds-C Trial. 57th AASLD. Boston, MA. October 27-31,
2006. Abstract 50.
J R Rodrigue, W Balistreri, B Haber, and others. 669.
Impact of Hepatitis C Virus (HCV) Infection in Children: Quality of Life, Emotional,
and Cognitive Outcomes, 57th AASLD. Boston, MA. October 27-31, 2006. Abstract
669.
60% of subjects
were male, ages ranged from 3.3 to 16.7 years (mean 10.4), and body mass index
(BMI) ranged from 12.1 to 32.4 (mean 20.5). 
