Course of Chronic Hepatitis C in Children Chronic
hepatitis C virus (HCV) infection has been extensively studied in adults,
but much less is known about the natural history and outcomes of the disease in
pediatric
patients.
 To
shed further light on this topic, Italian investigators assessed the long-term
course of chronic hepatitis C in a cohort of otherwise healthy children.
Between 1990 and 2005, they enrolled 504 children with detectable anti-HCV antibodies
at 12 centers.
Results
•
The presumed
route of HCV exposure was perinatal in 283 cases (56.2%), parenteral in 158 cases
(31.3%), and unknown in 63 cases (12.5%).
•
At baseline,
477 children (94.6%) had detectable HCV RNA.
•
Among these
patients, 118 (24.7%) were treated with conventional
interferon alfa.
•
Among 359 initially
HCV RNA positive but untreated children, 27 (7.5%) had undetectable HCV viral
load 10 years after presumed exposure.
•
Infection with
HCV genotype 3 was an independent predictor of spontaneous viral clearance.
•
332 children
(92.0%) had persistent HCV viremia after 10 years.
•
6 of these
children (1.8%) progressed to decompensated cirrhosis,
at a mean age of about 10 years.
•
This latter
group included 5 Italian children perinatally infected with HCV
genotype 1a, 4 of whom had mothers who were injection drug users.
•
33 of the treated
children (27.9%) achieved sustained virological
response.
Based
on these findings, the study authors concluded that, "Over the course of
a decade, few children with chronic HCV infection cleared viremia spontaneously,
and those who did were more likely to have genotype 3."
"Persistent
viral replication led to end-stage liver disease in a small subgroup characterized
by perinatal exposure, maternal drug use, and infection with HCV genotype 1a,"
they continued. "Children with such features should be considered for early
treatment."
6/17/08
Reference
F Bortolotti, G Verucchi,
C Camma, and others. Course of Chronic Hepatitis C in Children: From Viral Clearance
to End-Stage Liver Disease. Gastroenterology 134(7): 1900-1907. June 2008.
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