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

« Previous Next »The Journal of Pediatrics
Volume 150, Issue 2 , Pages 168-174.e1, February 2007

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

Departments of Gastroenterology and Nutrition and Laboratory Medicine and Pathology, Center for Health Services and Community Research, Children’s Research Institute, Children’s National Medical Center, the George Washington University School of Medicine, Washington, DC; and the Department of Transfusion Medicine, the National Institutes of Health, and the Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland.

Received 29 December 2005; received in revised form 5 October 2006; accepted 9 November 2006.

Objective

To define the natural history and outcomes of children infected with hepatitis C virus (HCV) at birth or in early childhood.

Study design

This retrospective, prospective study identified 60 HCV-infected children through a transfusion look-back program (group 1) and by referrals (group 2). Perinatal/transfusion history, clinical course, and laboratory studies were correlated with findings from 42 liver biopsy specimens.

Results

Mean age at infection was 7.1 months, and duration of infection 13.4 years. The sources of infection were blood transfusion (68%), perinatal transmission (13%), and both (7%). Most patients were asymptomatic; three referral patients had advanced liver disease at presentation. Mean alanine aminotransferase level was normal in 25%, 1 to 3 times normal in 62%, and greater than 3 times normal in 13%. Liver biopsy specimens showed minimal to mild inflammation in 71%, absent or minimal fibrosis in 88%, and bridging fibrosis in 12%. Age at infection and serum gamma-glutamyltranspeptidase correlated with fibrosis; serum alanine aminotransferase correlated with inflammation unless complicated by comorbidity. Repeat biopsies within 1 to 4 years in four patients showed no significant progression in three and cirrhosis in one. Two patients died after liver transplantation.

Conclusions

Children with chronic HCV infection are generally asymptomatic. By 13 years after infection, 12% of patients had significant fibrosis. Patients enrolled by referral had more severe liver disease than those identified through the look-back program, demonstrating the importance of selection bias in assessing the long-term outcome of HCV infection.

Abbreviations: ALT, Alanine aminotransferase, HCV PCR, Hepatitis C polymerase chain reaction, EIA, Enzyme immune assay, GGTP, Gamma-glutamyltranspeptidase, HAI, Histologic Activity Index, LKM, Liver kidney microsomal antibodies, RIBA, Recombinant immunoblot assay, ULN, Upper limit of normal