Long-Term Course of Chronic Hepatitis C in Children: From Viral Clearance to End-Stage Liver Disease

Flavia Bortolotti, Gabriella Verucchi, Calogero Cammà, Giuseppe Cabibbo, Lucia Zancan, Giuseppe Indolfi, Raffaella Giacchino, Matilde Marcellini, Maria Grazia Marazzi, Cristiana Barbera, Giuseppe Maggiore, Pietro Vajro, Samuela Bartolacci, Fiorella Balli, Anna Maccabruni, Maria Guido

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Abstract

Background & Aims: The natural course of chronic hepatitis C (CHC) in children is not well understood. The aim of this study was to assess the long-term course of CHC in a large sample of otherwise healthy children. Methods: From 1990 to 2005, 504 consecutive antihepatitis C virus (HCV)-positive children were enrolled at 12 centers of a national observatory and were followed up retrospectively/prospectively. Results: Putative exposure was perinatal in 283 (56.2%) cases, parenteral in 158 (31.3%), and unknown in 63 (12.5%). At baseline, 477 (94.6%) cases were HCV RNA seropositive, 118 (24.7%) of which were treated with standard interferon α. Ten years after putative exposure, the outcome in 359 HCV RNA-positive, untreated patients was (1) undetectable viremia in 27 (7.5%) (by Cox regression analysis, spontaneous viral clearance was independently predicted by genotype 3 [hazard ratio 6.44; 95% confidence interval: 2.7-15.5]) and (2) persistent viremia in 332 (92%) cases. Six of these 332 cases (1.8%) progressed to decompensated cirrhosis (mean age, 9.6 years). This latter group included 5 Italian children perinatally infected with genotype 1a (4 of the mothers were drug users). Thirty-three (27.9%) treated patients achieved a sustained virologic response. Conclusions: Over the course of a decade, few children with chronic HCV infection cleared viremia spontaneously, and those who did were more likely to have genotype 3. Persistent viral replication led to end-stage liver disease in a small subgroup characterized by perinatal exposure, maternal drug use, and infection with HCV genotype 1a. Children with such features should be considered for early treatment.

Original languageEnglish
Pages (from-to)1900-1907
Number of pages8
JournalGastroenterology
Volume134
Issue number7
DOIs
Publication statusPublished - Jun 2008

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ASJC Scopus subject areas

  • Gastroenterology

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Bortolotti, F., Verucchi, G., Cammà, C., Cabibbo, G., Zancan, L., Indolfi, G., Giacchino, R., Marcellini, M., Marazzi, M. G., Barbera, C., Maggiore, G., Vajro, P., Bartolacci, S., Balli, F., Maccabruni, A., & Guido, M. (2008). Long-Term Course of Chronic Hepatitis C in Children: From Viral Clearance to End-Stage Liver Disease. Gastroenterology, 134(7), 1900-1907. https://doi.org/10.1053/j.gastro.2008.02.082