Clinical Spectrum and Histopathologic Features of Chronic Hepatitis C Infection in Children - 12/08/11
, Camilla Colvin, MPH, BS, Chevelle Glymph, MPH, Roma R. Chandra, MD, David E. Kleiner, MD, Kantilal M. Patel, PhD †, Naomi L.C. Luban, MD, Harvey J. Alter, MD
Reprint requests: Parvathi Mohan, MD, Department of Gastroenterology and Nutrition, Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010.Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : ALT, HCV PCR, EIA, GGTP, HAI, LKM, RIBA, ULN
Plan
| The study was funded in part by a grant (RO1 HL 56060) from the National Institutes of Health. |
Vol 150 - N° 2
P. 168 - février 2007 Retour au numéro
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