Long-term course of chronic hepatitis C in children: from viral clearance to end-stage liver disease.
OBJECTIVE
The natural course of chronic hepatitis C (CHC) in children is not well understood. The aim of this study was to assess the long-term course of CHC in a large sample of otherwise healthy children.


METHODS
From 1990 to 2005, 504 consecutive antihepatitis C virus (HCV)-positive children were enrolled at 12 centers of a national observatory and were followed up retrospectively/prospectively.


RESULTS
Putative exposure was perinatal in 283 (56.2%) cases, parenteral in 158 (31.3%), and unknown in 63 (12.5%). At baseline, 477 (94.6%) cases were HCV RNA seropositive, 118 (24.7%) of which were treated with standard interferon alpha. Ten years after putative exposure, the outcome in 359 HCV RNA-positive, untreated patients was (1) undetectable viremia in 27 (7.5%) (by Cox regression analysis, spontaneous viral clearance was independently predicted by genotype 3 [hazard ratio 6.44; 95% confidence interval: 2.7-15.5]) and (2) persistent viremia in 332 (92%) cases. Six of these 332 cases (1.8%) progressed to decompensated cirrhosis (mean age, 9.6 years). This latter group included 5 Italian children perinatally infected with genotype 1a (4 of the mothers were drug users). Thirty-three (27.9%) treated patients achieved a sustained virologic response.


CONCLUSIONS
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. Children with such features should be considered for early treatment.
Bortolotti
Flavia
F
Clinica Medica 5, University of Padua, Padua, Italy. flavia.bortolotti@unipd.it
Verucchi
Gabriella
G
Cammà
Calogero
C
Cabibbo
Giuseppe
G
Zancan
Lucia
L
Indolfi
Giuseppe
G
Giacchino
Raffaella
R
Marcellini
Matilde
M
Marazzi
Maria Grazia
MG
Barbera
Cristiana
C
Maggiore
Giuseppe
G
Vajro
Pietro
P
Bartolacci
Samuela
S
Balli
Fiorella
F
Maccabruni
Anna
A
Guido
Maria
M
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000254:growth & development; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007223:Infant; D016898:Interferon-alpha / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000821:virology*; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis
D000998:Antiviral Agents; D016898:Interferon-alpha; D012367:RNA, Viral