Chronic hepatitis C in children - review of natural history at a National Centre

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J Viral Hepat. 2011 Oct;18(10):e535-40. doi: 10.1111/j.1365-2893.2011.01456.x.

Epub 2011 May 4.

Chronic hepatitis C in children - review of natural history at a National

Centre.

Abdel-Hady M, Bunn SK, Sira J, Brown RM, Brundler MA, Davies P, DA.

Source

Liver Unit, Birmingham Children's Hospital Royal Infirmary, Newcastle

upon Tyne Department of Cellular Pathology, University of Birmingham NHS

Foundation Trust Histopathology Department, Birmingham Children's Hospital

Institute of Child Health, Birmingham Children's Hospital, Birmingham, UK.

Abstract

Summary.  The natural history of hepatitis C virus (HCV) infection in adults

has been established, but less is known about outcome in children. We conducted

a retrospective review of patients referred to Birmingham Children's Hospital

Liver Unit, from 1991 till 2008, with the diagnosis of HCV was undertaken. Only

children with documented positive HCV RNA and a minimum duration of follow-up of

6 months were included. One hundred and thirty-three children were identified.

The route of transmission was transfusion acquired in 47%, vertically acquired

in 49% and transplantation in 2%. Since 2000, most children were infected

vertically. The overall rate of spontaneous viral clearance was 17.5% with

higher clearance (27%) in the transfusion group compared to the vertically

acquired group (9%). Seventy-six had a liver biopsy at diagnosis. There was no

evidence of fibrosis in 46%, mild fibrosis in 50% and moderate to severe

fibrosis in 4%. None had cirrhosis. There was a statistically significant

relationship between fibrosis score and older age at the time of biopsy

(P = 0.02) and longer duration of infection (P = 0.05). Eighty children

received treatment for HCV. Sustained viral response (SVR) was influenced by

viral genotypes, with significantly increased response rates in genotypes (G) 2

and 3 compared to G 1 and 4. Vertical infection is now the major route of HCV

infection in children in the UK. Histological changes were mild at diagnosis,

but the severity of fibrosis progressed with age. Consideration should be given

to improve detection and diagnosis to refer children to specialist centres for

management and antiviral therapy before developing fibrosis.

© 2011 Blackwell Publishing Ltd.

PMID: 21914074 [PubMed - in process]