Hepatitis C virus infection and related liver disease in children of mothers with antibodies to the virus

Bortolotti, Flavia; Resti, Massimo; Giacchino, Raffaella; Azzari, Chiara; Gussetti, Nadia; Crivellaro, Carlo; Barbera, Cristiana; Mannelli, Francesco; Zancan, Lucia; Bertolini, A.

doi:10.1016/s0022-3476(97)70289-0

Cited by 77 publications

(30 citation statements)

References 17 publications

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“…In children where liver biopsy has been carried out, histological findings show features of minimal to mild hepatitis but in few cases the liver damage may be severe [17][18][19]. Some studies [20][21][22] indicate that ·-interferon is well tolerated in the pediatric population but the effectiveness of this drug needs further evaluation in large multicenter trials.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study on Mother-to-Infant Transmission of Hepatitis C Virus

et al. 1998

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To assess the rate of mother-to-infant transmission of hepatitis C virus (HCV) and to identify potential risk factors for transmission, we followed up (mean 22.4 months, range 1–7.5 years) a cohort of 291 babies born to anti-HCV-positive mothers, 40 of whom were also HIV coinfected. Seventeen (5.8%) babies acquired HCV infection, but none became icteric. All babies developed chronic HCV infection with 16 babies showing elevated levels of ALT. The rate of transmission was higher in babies born to mothers coinfected with HIV than in those born to mothers with HCV alone (22.5 vs. 3.2%, p < 0.0001). No association was seen between a specific maternal HCV genotype and an increased risk of neonatal infection. The median level of HCV-RNA was higher in mothers who transmitted infection than in those who did not, although the ranges overlapped. In this study, maternal history of chronic liver disease, mode of delivery and type of feeding were not predictive of HCV infection.

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Section: Discussionmentioning

confidence: 99%

A Prospective Study on Mother-to-Infant Transmission of Hepatitis C Virus

et al. 1998

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“…The data for very early spontaneous resolution of mother-to-infant hepatitis C are compelling in those children who developed biochemical evidence of hepatic inflammation at the time of hepatitis C viremia. 44,[60][61][62][63] In one study, three fourths of the infants identified with mother-to-infant hepatitis C cleared the HCV RNA by 2 years of age. 23,64 In another study, all 5 infants with mother-to-infant hepatitis C lost detectable serum HCV RNA by 6 months of age.…”

Section: Outcome Of Mother-to-infant Hepatitis C In Affected Infantsmentioning

confidence: 99%

Maternal-infant transmission of hepatitis C virus infection

2002

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Mother-to-infant transmission of hepatitis C virus (HCV) is comparatively uncommon. The prevalence of antibody to HCV (anti-HCV) in pregnant women is 0.1% to 2.4%, although in some endemic areas it is much higher. The proportion of women with anti-HCV who have active infection with viremia is 60% to 70%. Transmission of HCV occurs only when serum HCV RNA is detectable and may be related to higher levels (above 10 6 copies per mL). M aternal and child health issues relating to hepatitis C virus (HCV) infection have recently assumed greater importance than ever before. From the pediatric perspective, the availability of effective screening methods for HCV has virtually eliminated new cases of transfusion-associated hepatitis C in children. Consequently, childhood acquisition of HCV infection through maternal-infant transmission has become the most important mode of spread. 1 Vertical, or more precisely, mother-to-infant hepatitis C will likely be the major type of childhood chronic hepatitis C within the next 6 to 8 years. It has been difficult to determine the rate of mother-to-infant transmission, partly because reports of mother-to-infant transmission of HCV have been based on small numbers of patients, with differing disease definitions, followed with different study designs and using different virological assays. These reports tended to be heterogeneous and conflicting. Moreover, factors that promote mother-to-infant transmission and the outcome of chronic HCV infection acquired by this route still require clarification. Likewise, for women of child-bearing age who acquired chronic hepatitis C in childhood or in early adulthood, there are important issues relating to pregnancy itself, such as its effect on the disease course of chronic hepatitis C. Prevalence of Hepatitis C Among Pregnant WomenNumerous studies have examined the prevalence of hepatitis C among pregnant women (Table 1). The studies vary considerably in terms of the size of the study, geographic variables, and adequacy of laboratory testing. In general, the prevalence of detectable antibody to HCV (anti-HCV) is approximately 1% overall (range, 0.1% to 2.4%), based on the studies that included at least 3,000 subjects. The mean Abbreviations: HCV, hepatitis C virus; anti-HCV, antibody to HCV; ALT, alanine aminotransferase; HIV, human immunodeficiency virus.

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“…Recent studies suggest that 80% of these children develop chronic infection (6-8), a rate similar to that documented in adults (9) but higher than that reported in children with posttransfusion HCV infection (10). Persistent HCV infection in infants and children is associated with minimal or mild liver damage and very rarely with advanced liver disease (5,(11)(12)(13)(14). However, perinatal HCV infection is associated with a wide range of aminotransferase levels during the first year of life (5, 7).…”

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Evolution of hepatitis C viral quasispecies and hepatic injury in perinatally infected children followed prospectively

Farci¹,

Quinti

Farci³

et al. 2006

Proc. Natl. Acad. Sci. U.S.A.

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Perinatal infection with hepatitis C virus (HCV) is characterized by a wide range of alanine aminotransferase (ALT) levels. The mechanisms responsible for this variability are unknown. We examined whether the evolution of the HCV quasispecies was associated with different ALT profiles in perinatally infected children. Sequences within HCV envelope 1 and 2 genes, inclusive of the hypervariable region 1, the viral load, and the nascent humoral immunity were analyzed in serial serum samples from 12 perinatally infected children prospectively followed for a median of 53 months. These patients were selected to represent two different ALT patterns during the first year of life: 6 had high levels (maximum values ranging from 4.2 to 30 times the normal upper limit), and 6 had normal or slightly elevated levels (<2 times the normal upper limit). Two patterns of viral evolution were identified according to the ALT profiles. Biochemical evidence of hepatic injury was invariably associated with a mono-or oligoclonal viral population, whereas mild or no liver damage correlated with the early emergence of a heterogeneous viral quasispecies. Consistent with selective immune pressure, amino acid changes occurred almost exclusively within the hypervariable region 1 and were temporally associated with antibody seroconversion; at this time, the difference in genetic diversity between the two groups was highly significant (P ‫؍‬ 0.002). The two patterns of viral evolution persisted over time and did not correlate with viral load or genotype. Our study demonstrates that, in perinatally infected children, the evolution of HCV quasispecies correlates with hepatic injury.perinatal hepatitis C virus infection ͉ genetic variability ͉ alanine aminotransferase levels M aternal-infant transmission is the dominant route for acquisition of hepatitis C virus (HCV) infection in children in developed countries, with an estimated transmission rate of Ϸ5% (1-3). Age and mode of infection are assumed to influence the progression of HCV disease in adults, but limited data are available on the natural history of perinatally acquired HCV infection (4, 5). Recent studies suggest that 80% of these children develop chronic infection (6-8), a rate similar to that documented in adults (9) but higher than that reported in children with posttransfusion HCV infection (10). Persistent HCV infection in infants and children is associated with minimal or mild liver damage and very rarely with advanced liver disease (5,(11)(12)(13)(14). However, perinatal HCV infection is associated with a wide range of aminotransferase levels during the first year of life (5, 7). Whereas some infants reach serum concentrations of alanine aminotransferase (ALT) compatible with acute hepatitis, others show normal or slightly elevated levels (5, 7). The mechanisms responsible for the different ALT profiles seen in perinatal HCV infection are unknown but are likely the result of a complex interplay between viral factors and host immunity. One of the most effective strategies enacted ...

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Hepatitis C virus infection and related liver disease in children of mothers with antibodies to the virus

Cited by 77 publications

References 17 publications

A Prospective Study on Mother-to-Infant Transmission of Hepatitis C Virus

A Prospective Study on Mother-to-Infant Transmission of Hepatitis C Virus

Maternal-infant transmission of hepatitis C virus infection

Evolution of hepatitis C viral quasispecies and hepatic injury in perinatally infected children followed prospectively

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