An updated follow-up of chronic hepatitis C after three decades of observation in pediatric patients cured of malignancy.
BACKGROUND
The aim of the study was to evaluate the clinical characteristics and the long-term outcome of chronic hepatitis C in a cohort of Caucasian children cured of pediatric malignancy.


METHODS
The study population included 83 consecutive patients, referred to our Center with a diagnosis of leukemia/lymphoma (50) or solid tumors (33) between 1977 and 1989 and infected with hepatitis C virus (HCV) during chemotherapy.


RESULTS
At enrollment 77 subjects were HCV-RNA positive. After a median follow-up of 21 years (range 13-36), a sustained virological response (SVR) was obtained in 3 of 29 patients (10%) treated with interferon (IFN), in 1 of 3 patients (33%) treated with IFN and ribavirin, and in 5 of 11 patients (42%) treated with pegylated-IFN and ribavirin (P = 0.03). Forty-two patients remained untreated and only one (2.5%) cleared viremia. Four of 77 patients (5%) developed cirrhosis while other 4 patients died of causes not related to liver. At last follow-up, 72% of HCV-RNA positive patients had abnormal ALT.


CONCLUSIONS
In patients cured of pediatric malignancy chronic hepatitis C tends to run an indolent course during childhood and adolescence but more than 70% of treated and more than 80% of untreated cases children maintained HCV viremia. Moreover, after 2-3 decades of observation, 60% of HCV-RNA positive patients had abnormal ALT and 5% had developed cirrhosis. Among treated patients, IFN or pegylated-IFN and ribavirin obtained the higher rate of HCV-RNA clearance.
Cesaro
Simone
S
Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy. simone.cesaro@unipd.it
Bortolotti
Flavia
F
Petris
Maria Grazia
MG
Brugiolo
Alessandra
A
Guido
Maria
M
Carli
Modesto
M
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000032:analysis / Q000378:metabolism; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis / Q000188:drug therapy / Q000821:virology; D005500:Follow-Up Studies; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D012333:RNA, Messenger / Q000235:genetics; D012254:Ribavirin / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D000998:Antiviral Agents; D012333:RNA, Messenger; D012254:Ribavirin; D007372:Interferons; D000410:Alanine Transaminase