Chronic Hepatitis C in Children: A Clinical and Immunohistochemical Comparative Study With Adult Patients

Abstract

Limited information is available regarding the characteristics of the hepatitis C virus (HCV) infection in children.We compared the epidemiological background along with the virological and histological features as well as the intrahepatic immunologic phenotype of both children and adults with chronic hepatitis C (CHC). Serum samples of 24 pediatric and 32 adult patients were drawn for alanine transaminase (ALT) levels, HCV-typing, and viral load. The histological diagnosis and a semiquantitative immunohistochemical assessment were performed in all patients. The majority of children (62%) had been transfused and the mean duration of viral infection in these cases was 11 ؎ 4 years, being similar in adults (11 ؎ 9 years, not significant). Although genotype distribution was similar, viral load was lower in children than in adults. The mildest histological forms of chronic hepatitis along with a weak intrahepatic immunological phenotype were significantly more frequent among children than adult patients. In conclusion, in children with CHC, perinatal blood transfusion was the most frequent source of viral infection and the liver disease was characterized by both low ALT level and viral load, as well as the mildest histological and immunohistochemical forms of chronic hepatitis. (HEPATOLOGY 1998;28:1696-1701.)Hepatitis C virus (HCV) is a recognized causative agent of blood-borne non-A, non-B hepatitis 1 and chronic liver disease in both adults and children. 2-4 Currently, six major HCV types have been recognized 5 and these have a significant effect on the course of HCV-induced liver disease. 6,7 In adult patients, the natural history of chronic HCV infection is becoming better understood. It is estimated that 65% of those infected will develop some degree of chronic liver disease. 8,9 In addition, a number of immunohistochemical studies performed in adult patients with chronic hepatitis C (CHC) strongly support the assumption that T-cell-mediated immune reactions play an important role in the pathogenesis of liver damage, showing a high number of liver-infiltrating activated T cells along with an intrahepatic up-regulated expression of antigen recognition and intercellular and vascular adhesion molecules, which are essential for the cytolytic immune response. [10][11][12][13] By contrast, little is known concerning the clinical features and the histological outcome of CHC when the HCV infection is acquired early in life. Therefore, the aims of the present study were, first, to compare the epidemiological, clinical, virological, and histological features of both children and adult patients with CHC and, second, to characterize by immunohistochemistry the intrahepatic immunological phenotype of these patients. PATIENTS AND METHODS PatientsTwenty four Spanish children, who were referred to the Pediatric Hepatology Unit of the Hospital La Paz in Madrid, Spain because of persistently elevated serum alanine transaminase (ALT) levels, were included in this study. The diagnosis of CHC was further based on the presence of bo...

Effect of host-related factors on the intensity of liver fibrosis in patients with chronic hepatitis C virus infection

“…Studies conducted on children and adolescents have demonstrated a clinically benign course of HCV infection in this age group [13][14][15]. These studies reinforce the influence of age on the natural history of hepatitis C. On the other hand, studies conducted on older patients contaminated through blood transfusion have reported cirrhosis in about 50% of cases [3,16,17].…”

Non--Organ-Specific Autoantibodies in Children with Chronic Hepatitis C: Clinical Significance and Impact on Interferon Treatment

“…The course of HCV-associated chronic liver disease in children is usually milder than it is in adults, with lower levels of ALT, lower histological activity, and lower HCV levels, even without differences in HCV genotype distribution [18][19][20][21]. In keeping with observations in adult patients, the occurrence of NOSA has been described also in children [10,11].…”

Recombinant alfa-interferon plus ribavirin therapy in children and adolescents with chronic hepatitis C

“…According to current knowledge the inflammatory activity in liver tissue is usually mild at the time of diagnosis and may remain at a low level over more than 10 to 15 years. 6,7 The risk for developing cirrhosis probably will not exceed around 5% until adulthood. 8,9 Nevertheless, in single cases progressive liver diseases will occur and besides that the majority of infected individuals remain infectious.…”