Chronic Hepatitis C Virus Infection in Childhood: Clinical Patterns and Evolution in 224 White Children

Jara, Paloma; Resti, Massimo; Giacchino, Raffaella; Barbera, Cristiana; Zancan, Lucia; Crivellaro, Carlo; Sokal, Étienne; Azzari, Chiara; Guido, Maria; Bortolotti, Flavia

doi:10.1086/345908

Cited by 169 publications

(144 citation statements)

References 29 publications

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“…3,18 At birth, HCV-RNA was negative in all our patients, confirming data reported by others. 19 The test became positive by 3 months of age, with the exception of one child who remained negative up to 12 months , but this patient had presented with high ALT levels since the age of 3 months. These results could be caused by the small quantity of circulating virus during the first few months of life in an infant with recent acute infection, together with the suboptimal sensitivity of the PCR test (sensitivity 97%; lower limit of detection 100 IU/ml).…”

Section: Discussionmentioning

confidence: 85%

Longitudinal Long-term Follow-up Study of Children with Vertically Acquired Hepatitis C Virus Infection

et al. 2006

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Seventeen children with vertically acquired hepatitis C virus (HCV) infection were followed from birth for a mean of 104 months. Alanine aminotransferase (ALT) levels were increased significantly at 3 and 6 months of age but were stable thereafter. HCV polymerase chain reaction was positive at 3 months in 16 patients and at 12 months in one patient. Viral load remained stable during followup at a mean value of 5.4 ± 0.4 log 10 . Mild chronic hepatitis was the most common histopathological feature on liver biopsy, occurring in six of the seven children biopsied at a mean age of 4.0 ± 2.4 years. Genotype did not seem to be related to the type of liver involvement. The results of this study suggest that vertically acquired HCV infection has a benign course in children, despite the presence of viraemia and persistent alterations in ALT levels.

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Section: Discussionmentioning

confidence: 85%

Longitudinal Long-term Follow-up Study of Children with Vertically Acquired Hepatitis C Virus Infection

et al. 2006

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“…These results would be comprehensible with the knowledge of spontaneous viral elimination on long-term follow-up, which is much less in vertically infected children, reflecting a higher immune tolerance to the virus. 4,5,17 However, further studies with larger numbers of patients have to elucidate whether there is a different response rate in relation to mode of transmission.…”

Section: Discussionmentioning

confidence: 99%

“…In vertically infected patients, long-term spontaneous clearance of chronic HCV is low, and both liver cirrhosis and hepatocellular carcinoma are common late complications in adulthood. [4][5][6] Furthermore, potential infectivity and a substantial social burden during the entire childhood remain, which may lead to social disintegration in some cases.…”

mentioning

confidence: 99%

Peginterferon alfa‐2b plus ribavirin treatment in children and adolescents with chronic hepatitis C†

et al. 2005

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Peginterferon plus ribavirin is standard therapy for adults with chronic hepatitis C. As no data are available for children, the aim of the study was to evaluate the efficacy and tolerability of peginterferon alfa-2b in combination with ribavirin in chronically infected children. Genotypes, alanine aminotransferase levels, and different routes of viral transmission were considered. In an open-labeled, uncontrolled pilot study, 62 children and adolescents (range, 2-17 years) were treated with subcutaneous peginterferon alfa-2b at a dose of 1.5 g/kg body weight once per week plus oral ribavirin (15 mg/kg ؋ day) for 48 weeks. Sixty-one patients completed the study. Twenty-three children discontinued therapy after 6 months according to study protocol. P eginterferon alfa and ribavirin is established as standard treatment in adults with chronic hepatitis C (HCV). International studies have yielded sustained viral response rates (SVR) between 44% and 75% according to the genotype. 1,2 Whereas interferon alfa-2b and ribavirin has been approved for individuals between 3 and 18 years of age in the United States, the indication for therapy in children and adolescents is still debated in many countries. One reason may be that ribavirin has teratogenic or embryocidal effects in animals. The risk of ribavirin as a carcinogen in humans has not been established. For more than 20 years, the substance has been used in infants for other indications, such as respiratory syncytial virus infection.The usage of peginterferon has improved response rates in adults by approximately 10% compared with a treatment regimen with interferon-alfa and ribavirin. Moreover, dosing of peginterferon once per week is another considerable advantage. No treatment study with peginterferon-alfa and ribavirin in children and adolescents with chronic HCV has been published so far.Chronic HCV in childhood features particular issues regarding mode of infection, immunological competence, and inflammatory activity. Vertical infection is the most important route of viral transmission. 3 These children are infected at a phase of high immune tolerance. A considerable number of young individuals display normal aminotransferases, reflecting a low inflammatory activity. Despite a relatively low disease progression during the first 15 to 20 years of life, severe liver disease occasionally occurs during childhood. In vertically infected patients, long-term spontaneous clearance of chronic HCV is low, SVR, sustained viral response; HCV RNA, hepatitis C virus ribonucleic acid; ALT, alanine aminotransferase. From the

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“…Liver disease appears to be milder in children than in adults; however, the natural history of chronic HCV infection acquired in infancy and childhood remains poorly characterised (Jara et al 2003). Most available information regarding paediatric HCV infection is derived from a limited number of studies (Tovo et al 2000).…”

mentioning

confidence: 99%

Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

Nassef

Shady

Galal

et al. 2013

Mem. Inst. Oswaldo Cruz

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Chronic Hepatitis C Virus Infection in Childhood: Clinical Patterns and Evolution in 224 White Children

Cited by 169 publications

References 29 publications

Longitudinal Long-term Follow-up Study of Children with Vertically Acquired Hepatitis C Virus Infection

Longitudinal Long-term Follow-up Study of Children with Vertically Acquired Hepatitis C Virus Infection

Peginterferon alfa‐2b plus ribavirin treatment in children and adolescents with chronic hepatitis C†

Performance of diagnostic biomarkers in predicting liver fibrosis among hepatitis C virus-infected Egyptian children

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