Dr Parvathi Mohan and colleagues from Washington defined the natural history and outcomes of children infected with Hepatitis C virus at birth or in early childhood.
The team of doctors conducted a retrospective, prospective study and identified 60 Hepatitis C virus-infected children.
Patients in Group 1 were identified by a transfusion look-back program.
The doctors identified patients allocated to Group 2 by referrals.
Perinatal/transfusion history, clinical course, and laboratory studies were correlated with findings from 42 liver biopsy specimens.
|By 13 years after infection, 12% of patients had fibrosis|
|Journal of Pediatrics|
The doctors observed that the mean age at infection was 7 months.
Duration of infection was 13 years.
The sources of infection were blood transfusion in 68%, perinatal transmission in 13%, and both occurred in 7%.
The team found that most patients were asymptomatic.
The doctors observed that 3 referral patients had advanced liver disease at presentation.
Mean alanine aminotransferase level was normal in 25%.
The team noted that alanine aminotransferase levels were 1 to 3 times normal in 62%, and greater than 3 times the normal level in 13%.
Liver biopsy specimens showed minimal to mild inflammation in 71%, absent or minimal fibrosis in 88%, and bridging fibrosis in 12%.
The doctors identified that 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 4 patients showed no significant progression.
The doctors reported that 2 patients died after liver transplantation.
Dr Mohan's team concludes, “Children with chronic Hepatitis C virus 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.”
“This demonstrates the importance of selection bias in assessing the long-term outcome of Hepatitis C virus infection.”