title: Natural history of vertically acquired HCV infection and associated autoimmune phenomena.
abstract: The natural history of vertically acquired HCV infection is ill defined. The aim of this study was to outline the natural course of vertical HCV infection in a cohort of untreated children, including rate of spontaneous viral clearance, frequency and features of HCV-related autoimmune disorders. Children with vertical HCV infection were prospectively followed from the first month of life with regular clinical and laboratory assessments. Statistical analysis was performed using Prism 5.0. Forty-five children (median age 12 years, interquartile range 6.9-15.5) were studied. Genotype 1 was predominant (53.3 %). Spontaneous viral clearance was achieved by 12 patients (26.7 %) and associated with genotype 3. Alanine-amino-transferase levels were increased in most children in the first 2 years of life with higher values in those who later cleared the infection. All children were asymptomatic for liver disease. Transient elastography (32 patients) showed mild or moderate fibrosis in nine and two cases, respectively. Non-organ-specific autoantibodies were detected in 24 children (53.3 %) independently of viremia; of these, one developed type-1 diabetes. Cryoglobulinemia was associated with genotype 1 infection and found in 15 subjects (33.3 %): two had low C4 levels and persistent proteinuria.
  
  
  CONCLUSIONS
  Vertically acquired HCV infection may result in spontaneous clearance in up to 27 % of children. Resolution of infection is higher with genotype 3, usually occurs in preschool age and persists over time. Chronic infection is generally asymptomatic, although hepatomegaly and mild fibrosis may develop. Autoantibodies and cryoglobulins are frequent, whereas the associated clinical manifestations are rare.
authors.affiliation: Department of Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy, silvia.garazzino@unito.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Garazzino
authors.forename: Carmelina
authors.initials: C
authors.lastname: Calitri
authors.forename: Antonella
authors.initials: A
authors.lastname: Versace
authors.forename: Alda
authors.initials: A
authors.lastname: Alfarano
authors.forename: Carlo
authors.initials: C
authors.lastname: Scolfaro
authors.forename: Chiara
authors.initials: C
authors.lastname: Bertaina
authors.forename: Simona
authors.initials: S
authors.lastname: Vatrano
authors.forename: Federica
authors.initials: F
authors.lastname: Mignone
authors.forename: Francesco
authors.initials: F
authors.lastname: Licciardi
authors.forename: Clara
authors.initials: C
authors.lastname: Gabiano
authors.forename: Pier-Angelo
authors.initials: PA
authors.lastname: Tovo
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000276:immunology / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D003449:Cryoglobulinemia / Q000097:blood; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000502:physiology*; D006526:Hepatitis C / Q000276:immunology / Q000635:transmission* / Q000821:virology*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008928:Mitochondria / Q000276:immunology; D009130:Muscle, Smooth / Q000276:immunology; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics; D019562:Viral Load
chemical_list: D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D012367:RNA, Viral; C060729:anti-liver kidney microsome antibody; D000410:Alanine Transaminase