Clinical Spectrum and Histopathologic Features of Chronic Hepatitis C Infection in Children

Mohan, Parvathi; Colvin, Camilla; Glymph, Chevelle; Chandra, Roma R.; Kleiner, David E.; Patel, Kantilal M.; Luban, Naomi L.C.; Alter, Harvey J.

doi:10.1016/j.jpeds.2006.11.037

Cited by 86 publications

(73 citation statements)

References 40 publications

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“…The largest published series with sufficient detail [4][5][6][7][8][9][10] for comparison are listed in Table 7. There is some degree of overlap in the patients in several of these reports.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 One of the previous US series 5 had 3 of 40 patients with cirrhosis. The US series of Mohan et al 10 had 1 patient who developed cirrhosis on a subsequent biopsy. The current series found cirrhosis in 2 of 121 patients.…”

Section: Discussionmentioning

confidence: 99%

“…24 The current series found 42% and the other two US series 50% and 10%. 5,10 Thus, it appears that there may be geographic trends, with more steatosis in the United States. Both the current series and that of Guido et al 9 found a correlation of BMI with the degree of steatosis, as in adults.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 By contrast, relatively few children with chronic hepatitis C undergo liver biopsy, and there are only a few published series describing the range of histopathology in a significant number of patients. [4][5][6][7][8][9][10] In general, these have found that children tend to have milder disease than adults, with less inflammation, steatosis, and fibrosis, but with some variation between series collected in different parts of the world.…”

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confidence: 99%

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Pathology of chronic hepatitis C in children: Liver biopsy findings in the Peds-C Trial

Goodman¹,

Makhlouf²,

Liu³

et al. 2008

Hepatology

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173

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There is relatively little information in the literature on the histopathology of chronic hepatitis C in children. The Peds-C Trial, designed to test the efficacy and safety of peginterferon alfa-2a and ribavirin in children, provided an opportunity to examine liver biopsies from 121 treatment-naïve children, ages 2 to 16 (mean, 9.8 years) infected with the hepatitis C virus (HCV) and with no other identifiable cause for liver disease, signs of hepatic decompensation, or another significant nonhepatic disease. Liver biopsies were scored for inflammation, fibrosis, steatosis, and other histological features. Inflammation in the biopsy was minimal in 42%, mild in 17%, moderate in 38%, and severe in only 3%. Five had bridging fibrosis, and 2 had cirrhosis. Steatosis was absent in 56%, minimal in 34%, and mild in 10%. Inflammation scores correlated with fibrosis scores, serum alanine aminotransferase levels, and duration of infection, but not with age, body mass index z score, or HCV genotype. Fibrosis scores correlated with inflammation but not with age, HCV genotype, body mass index z score, or steatosis parameters. Steatosis correlated with serum alanine aminotransferase levels and body mass index z scores; overweight children had more fibrosis than the non-overweight. In conclusion, in this cohort of HCV-infected children, inflammation, fibrosis, and steatosis were milder than reported for treatment-naïve adults with chronic hepatitis C, but there were several with bridging fibrosis or cirrhosis. The positive correlation of inflammation with duration of infection and fibrosis and of obesity with fibrosis suggest that children with chronic hepatitis C will be at risk for progressive liver disease as they age and possibly acquire other comorbid risk factors. (HEPATOLOGY 2008;47:836-843.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pathology of chronic hepatitis C in children: Liver biopsy findings in the Peds-C Trial

Goodman¹,

Makhlouf²,

Liu³

et al. 2008

Hepatology

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173

138

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“…Hepatitis C is a progressive disease, with 10-20% of infected patients developing cirrhosis and about 7% of adult patients with cirrhosis progressing to hepatocellular carcinoma [3,4]. However, little is known about the disease progression in patients infected in childhood and, to date, only sparse and inconsistent data are available regarding liver histopathology in HCV-infected children [5,6,7]. In addition, the relevance of different markers as predictors of chronic disease progression is not well studied [4,6].…”

Section: Introductionmentioning

confidence: 99%

Determinants of liver disease progression in children with chronic hepatitis C virus infection

Pokorska‐Śpiewak¹,

Kowalik-Mikołajewska²,

Aniszewska³

et al. 2015

pjp

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Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus

Curtis,

Epstein,

Pei

et al. 2024

JAMA Pediatr

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ImportancePrevalence of chronic hepatitis C virus (HCV) infection among pregnant people is increasing in the US. HCV is transmitted vertically in 7% to 8% of births. Direct-acting antiviral (DAA) therapy was recently approved for children with HCV who are 3 years or older. The clinical and economic impacts of early DAA therapy for young children with HCV, compared with treating at older ages, are unknown.ObjectiveTo develop a state-transition model to project clinical and economic outcomes for children with perinatally acquired HCV to investigate the cost-effectiveness of treating at various ages.Design, Setting, and ParticipantsThe study team modeled the natural history of perinatally acquired HCV to simulate disease progression and costs of a simulated a cohort of 1000 US children with HCV from 3 years old through death. Added data were analyzed January 5, 2021, through July 1, 2022.InterventionsThe study compared strategies offering 8 weeks of DAA therapy at 3, 6, 12, or 18 years old, as well as a comparator of never treating HCV.Main Outcomes and MeasuresOutcomes of interest include life expectancy from 3 years and average lifetime per-person health care costs. Other clinical outcomes include cases of cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).ResultsThe study team projected that treating HCV at 3 years old was associated with lower mean lifetime per-person health care costs ($148 162) than deferring treatment until 6 years old ($164 292), 12 years old ($171 909), or 18 years old ($195 374). Projected life expectancy was longest when treating at 3 years old (78.36 life years [LYs]) and decreased with treatment deferral until 6 years old (76.10 LYs), 12 years old (75.99 LYs), and 18 years old (75.46 LYs). In a cohort of 1000 children with perinatally acquired HCV, treating at 3 years old prevented 89 projected cases of cirrhosis, 27 cases of HCC, and 74 liver-related deaths compared with deferring treatment until 6 years old. In sensitivity analyses, increasing loss to follow-up led to even greater clinical benefits and cost savings with earlier treatment.Conclusions and RelevanceThese study results showed that DAA therapy for 3-year-old children was projected to reduce health care costs and increase survival compared with deferral until age 6 years or older. Measures to increase DAA access for young children will be important to realizing these benefits.

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Clinical Spectrum and Histopathologic Features of Chronic Hepatitis C Infection in Children

Cited by 86 publications

References 40 publications

Pathology of chronic hepatitis C in children: Liver biopsy findings in the Peds-C Trial

Pathology of chronic hepatitis C in children: Liver biopsy findings in the Peds-C Trial

Determinants of liver disease progression in children with chronic hepatitis C virus infection

Cost-Effectiveness of Strategies for Treatment Timing for Perinatally Acquired Hepatitis C Virus

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