Hepatitis C in childhood

Abstract

The approach of a pediatric hepatologist in managing children with hepatitis C virus (HCV) differs from adult practice, because the pediatric hepatologist is dealing with the beginning of a chronic illness in which long-term outcomes will not occur for 20 or 40 years, and it is not possible to predict in the early stages of the infection which patients have a more sinister prognosis. The prevalence of chronic HCV in children is low, but varies between different countries in the Asia-Pacific region. In most countries, screening of blood products for HCV has virtually eliminated the risk of post-transfusion HCV, so that in Australia children aged less than 11 years will not have acquired HCV from blood transfusion or extracorporeal membrane oxygenation. The risk of perinatal transmission of this virus is only about 6%, but this remains virtually the only source of HCV transmission for children in most countries. While available data are limited, mild histological changes are present in the majority of children with hepatitis C, and cirrhosis is rare. Unfortunately, long-term natural history studies of the course of HCV infection in children have not been reported. Individual decisions on antiviral treatment are more difficult in childhood, not because the treatment is any less effective or because of the severity of side-effects (which tend to be less severe than for adults), but because the long-term outcome of infection is unclear. At present, treatment should be confined to those with significant hepatic fibrosis and continued moderate to severe necroinflammatory change. Measures to prevent HCV infection in childhood center on whether, as recently suggested, elective cesarean section may reduce the risk of transmission. Despite the presence of HCV-RNA in some breast milk samples, there is no evidence that breast-feeding confers any risk of HCV infection.

Long‐term outcome of vertically acquired and post‐transfusion hepatitis C infection in children

“…Although a correlation between ALT level and histological abnormality in children with chronic HCV has been reported, 23 liver histology remains the gold standard for measurement of disease activity and prediction of prognosis and progression 5,24 . Because of a lack of evidence supporting the need for liver biopsy in children with normal or minimal abnormalities in liver function tests, only four of our patients who had significant biochemical abnormality underwent liver biopsy.…”

Hepatitis C Virus Infection in Infants and Children from Argentina

“…Future analysis of the HCV 5ЈUTR sequence will allow us to define the HCV genotype more accurately in such samples. A helpful approach for the detection of HCV RNA in the population studied was the evaluation of HCV viral load, which is recommended worldwide for monitoring HCV therapy (16,20). In this study, we used HCV viral load to evaluate the progression of HCV replication in the host.…”

“…Long-term outcome is relevant in pediatric patients, as they may still be young adults after 20 to 40 years of infection. Furthermore, it is not feasible to predict in the early stages which patients have a more somber prognosis (16,17).…”

“…It has been documented that persistent infection develops in 85% of infected newborns, whereas chronic hepatitis and cirrhosis have been found in 70 and 20%, respectively, of those chronically infected (31). Furthermore, persistent viremia in children has been estimated to range from 45 to 86% of cases (16) and shown to remain relatively stable in one patient over time (4).…”

“…Considering the silent evolution of HCV infection in children, periodic screening of the infection has become mandatory to prevent liver complications and to predict which patients will develop a more aggressive disease (3,16).…”