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

Abstract

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.)

Ombitasvir/Paritaprevir/Ritonavir With or Without Dasabuvir and With or Without Ribavirin for Adolescents With HCV Genotype 1 or 4

“…However, if left untreated, chronic HCV infection can predispose pediatric patients to liver‐related complications, including cirrhosis and advanced liver disease 9, 10. Therefore, curative treatment of HCV infection should be considered for children and adolescents to mitigate the risk of liver disease progression, reduce the rates of transmission, and lessen the social stigma that can be associated with HCV infection.…”

Hepatitis C virus infection in children and adolescents

“…Decompensated cirrhosis in children as young as 4 years of age has been described 48, 78, 91, 92. HCV infection in children has also been suggested to negatively affect both health‐related quality of life and cognitive functioning; however, these findings would need to be confirmed in larger cohorts 93, 94…”

The clinical effectiveness and cost-effectiveness of peginterferon alfa and ribavirin for the treatment of chronic hepatitis C in children and young people: a systematic review and economic evaluation

“…Data were extracted from the seven studies 12,75,91,[93][94][95][96] identified and then pooled to give an estimate for the annual transition probability between mild HCV and moderate HCV, and moderate HCV and compensated cirrhosis. The transition probabilities used in the model for all other transitions were the same as for the previous NICE appraisals.…”