title: Clinical spectrum and histopathologic features of chronic hepatitis C infection in children.
abstract: OBJECTIVE
  To define the natural history and outcomes of children infected with hepatitis C virus (HCV) at birth or in early childhood.
  
  
  METHODS
  This retrospective, prospective study identified 60 HCV-infected children through a transfusion look-back program (group 1) and by referrals (group 2). Perinatal/transfusion history, clinical course, and laboratory studies were correlated with findings from 42 liver biopsy specimens.
  
  
  RESULTS
  Mean age at infection was 7.1 months, and duration of infection 13.4 years. The sources of infection were blood transfusion (68%), perinatal transmission (13%), and both (7%). Most patients were asymptomatic; three referral patients had advanced liver disease at presentation. Mean alanine aminotransferase level was normal in 25%, 1 to 3 times normal in 62%, and greater than 3 times normal in 13%. Liver biopsy specimens showed minimal to mild inflammation in 71%, absent or minimal fibrosis in 88%, and bridging fibrosis in 12%. Age at infection and serum gamma-glutamyltranspeptidase correlated with fibrosis; serum alanine aminotransferase correlated with inflammation unless complicated by comorbidity. Repeat biopsies within 1 to 4 years in four patients showed no significant progression in three and cirrhosis in one. Two patients died after liver transplantation.
  
  
  CONCLUSIONS
  Children with chronic HCV infection are generally asymptomatic. By 13 years after infection, 12% of patients had significant fibrosis. Patients enrolled by referral had more severe liver disease than those identified through the look-back program, demonstrating the importance of selection bias in assessing the long-term outcome of HCV infection.
authors.affiliation: Department of Gastroenterology and Nutrition, Children's National Medical Center, Washington, DC 20010, USA. pmohan@cnmc.org
authors.forename: Parvathi
authors.initials: P
authors.lastname: Mohan
authors.forename: Camilla
authors.initials: C
authors.lastname: Colvin
authors.forename: Chevelle
authors.initials: C
authors.lastname: Glymph
authors.forename: Roma R
authors.initials: RR
authors.lastname: Chandra
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Kantilal M
authors.initials: KM
authors.lastname: Patel
authors.forename: Naomi L C
authors.initials: NL
authors.lastname: Luban
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Alter
mesh_terms: D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D018937:Hepatitis C Antibodies / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D016015:Logistic Models; D008297:Male; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D065227:Transfusion Reaction
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral