Advanced liver disease in Russian children and adolescents with chronic hepatitis C

Abstract

Summary Russia has one of the highest prevalences of paediatric chronic hepatitis C infection (CHC). Our aim was to provide a detailed characterization of children and adolescents with CHC including treatment outcomes. Thus, an observational study of children with CHC aged <18 years was conducted in three hepatology centres from November 2014 to May 2017. Of 301 children (52% male), 196 (65%) acquired HCV vertically, 70 (23%) had a history of blood transfusion or invasive procedures, 1 injecting drug use and 34 (11%) had no known risk factors. Median age at HCV diagnosis was 3.1 [interquartile range, IQR 1.1, 8.2] and 10.8 [7.4, 14.7] at last follow‐up. The most common genotype was 1b (51%), followed by 3 (37%). Over a quarter of patients (84, 28%) had raised liver transaminases. Of 92 with liver biopsy, 38 (41%) had bridging fibrosis (median age 10.4 [7.1, 14.1]). Of 223 evaluated by transient elastography, 67 (30%) had liver stiffness ≥5.0 kPa. For each year, increase in age mean stiffness increased by 0.09 kPa (95% CI 0.05, 0.13, P < 0.001). There was significant correlation between liver stiffness and biopsy results (Tau‐b = 0.29, P = 0.042). Of 205 treated with IFN‐based regimens, 100 (49%) had SVR24. Most children (191, 93%) experienced adverse reactions, leading to treatment discontinuation in 6 (3%). In conclusion, a third of children acquired HCV via nonvertical routes and a substantial proportion of those with liver biopsy had advanced liver disease. Only half of children achieved SVR24 with IFN‐based regimens highlighting the need for more effective and better‐tolerated treatments with direct‐acting antivirals. Further studies are warranted in Russia on causes and prevention of nonvertical transmission of HCV in children.

Assessment of liver fibrosis by transient elastography in young children with chronic hepatitis B virus infection

“…The discrepancies between the findings of these studies may be due to differences in the age of the participants at the time of enrolment, as well as the causes of liver disease [ 19 ]. Consistent with our findings, the study by Anna et al reported LSM of 5.4 (95% CI 4.0, 7.1) kPa for the F2 stage in children with CHC [ 20 ]. Moreover, a previous study demonstrated that the LSM was able to adequately predict the liver fibrosis stage in adult patients with CHB.…”

Assessment of Liver Fibrosis by Transient Elastography in Children with Chronic Hepatitis B Virus Infection

“…The discrepancies between the ndings of these studies may be due to differences in the age of the participants at the time of enrolment and causes of the disease [19]. Consistent with our ndings, the study by Anna et al reported an LSM of 5.4 (4.0, 7.1) kPa for the F2 stage in children with CHC (20). Moreover, a previous study demonstrated that LSM was able to adequately predict the liver brosis stage in adult patients with CHB, and the ROC curves were 0.81 for F0-F1 vs F2-F4 and 0.93 for F0-F2 vs F3-F4 [21], which is consistent with the children with CHB in our study.…”

Nonfasted Liver Stiffness Correlates with Liver Disease Parameters and Portal Hypertension in Pediatric Cholestatic Liver Disease

“…(12)(13)(14) The largest TE studies in children with liver disease have examined LSMs in liver transplant recipients (n = 117), cystic fibrosis (n = 249), hepatitis C (n = 223), fatty liver disease (n = 106), and BA (n = 100). (3,(15)(16)(17)(18) These studies correlate LSM with a variety of disease parameters, including clinical features of liver disease, manifestations of portal hypertension, and histologic assessment of fibrosis. The FORCE protocol is unique in that it has been developed in the context of three large-scale, prospective, multicenter, observational studies that collected comprehensive and high-quality clinical metadata in three major etiologies of neonatal cholestasis: BA, ALGS, and A1ATD.…”