Guest guest Posted August 21, 2001 Report Share Posted August 21, 2001 Thanks Claudine, I've read and sent all 3 articles about HCV and children to Pat...she sent an email and said, " thank you! " I also told her about this group and how it's real good for exchanging HCV info. Actually, this is the most informative HCV e-group that I belong to. God bless, > Taken from: > Recovery, Persistence, and Sequelae in Hepatitis C > Infection: continued... > [sem Liver Disease 20(1):17-35,2000. © 2000 Thieme > Medical Publishers, Inc.] > > > -------------------------------------------------------------------- ------------ > > Outcome in Children > Data from studies of infants and children are just > beginning to emerge. Hepatitis C infection is not > common in children because perinatal spread is > uncommon and because needle exposures are generally > limited to blood transfusion. The National Health and > Nutrition Epidemiologic Survey shows that the > prevalence of anti-HCV in children aged 6-11 is only > 0.2% and rises to only 0.4% in those aged 12-19.[15] > One of the most comprehensive outcome studies in > children was conducted by Vogt et al. in Germany,[45] > who enrolled 458 children who had cardiac surgery > before the implementation of blood donor screening > (Table 1). The patients had undergone cardiac surgery > a mean of 17 years (range, 12-27 years) earlier at a > mean age at first operation of 2.8 years. None had > received prior or subsequent transfusions and none had > mothers with detectable HCV infection. An age- and > sex-matched control group from the general population > was also studied. Anti-HCV was detected in 67 (14.6%) > patients compared with 3 (0.7%) among the controls. At > follow-up evaluation, 37 patients (55%) were HCV RNA > positive and 45% appeared to have spontaneously > cleared the infection. All but one patient was found > to have normal ALT values, and this single patient had > severe right-sided congestive heart failure. Of the 17 > patients who underwent liver biopsy, only 2 had > histologic evidence of portal fibrosis, and both these > patients had chronic congestive heart failure that > might have accounted for the observed changes. One > additional patient had " micronodular " cirrhosis, but > this person was co-infected with the hepatitis B virus > (HBV), and the relative role of HCV in the > pathogenesis of the cirrhosis could not be > established. > The study of Vogt et al. is the largest reported > outcome study in children and describes a relatively > benign course for transfusion-associated hepatitis C > over a period of near 20 years. Importantly, they also > found that almost one half of the infected children > had spontaneously cleared HCV over this interval. The > authors concluded that the natural history of chronic > hepatitis C in childhood is either more benign or more > slowly progressive than in adults. > > Losasciulli et al.[46] reported serologic and > molecular follow-up data on 114 children with > childhood leukemia of whom 56 (49%) were HCV RNA > positive at the end of chemotherapy. Seventeen year > follow-up of the HCV RNA positive cohort revealed that > all were asymptomatic, that ALT values were normal in > 71%, and that 16 of the 56 (29%) had spontaneously > cleared their viremia. No liver biopsy data was > reported in this study. A small study by -Monzon > et al.[47] compared the outcome in 24 HCV-infected > children and 22 HCV-infected adults. After a mean > follow-up of 11 years, the comparative outcomes for > children versus adults were as follows: mean viral > load 3.6 2105 versus 5.6 2105 copies/mL, histologic > grade (scale 0-4) 0.6 ± 0.7 versus 3.2 ± 1.1, and > histologic stage (scale 0-4) 0.5 ± 0.5 versus 2.6 ± > 1.2. Thus, despite similar viral loads, both hepatic > inflammation and fibrosis were markedly less in > children than adults. > > Luban et al.[48] recently provided an interim report > of a look-back study of 5,446 pediatric recipients of > blood administered between 1982 and 1992. The mean age > at transfusion was 1.0 year (range, birth to 10.7 > years). The mean age at testing was 11 years (range, > 4-17 years). Of 1,753 recipients thus far tested, 36 > (2.0%) are confirmed anti-HCV positives compared with > 0.3% of an age-matched nontransfused control > population. Of the 36 HCV-positive children, all are > asymptomatic. The range of ALT was 29-140 IU/L and 80% > had at least one ALT value greater than 1.5 times the > upper limit of normal. Thus far, only 7 of the 36 have > been biopsied. After a mean interval of 13.6 years > since exposure to blood, six patients showed only mild > inflammation without fibrosis and one patient had mild > inflammation with early bridging fibrosis. > > Thus, although data from pediatric follow-up studies > are still sparse, the available data consistently show > mild outcomes over the first two decades of infection > with a high rate of spontaneous recovery (29-45%) as > assessed by the loss of HCV RNA. Nonetheless, it is > unclear whether hepatitis C is actually milder in > children or just more slowly progressive. If the > latter, then the long-anticipated lifespan of infected > children would allow them to eventually reach the same > levels of cirrhosis and HCC as persons infected later > in life. It is critical that these childhood cohorts > continue to be followed and reported and that > additional studies be undertaken among children > infected 10 or more years ago. > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
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