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Hepatitis C virus infection in children
M Ruiz-Moreno1, A Leal-Orozco, A Millàn
1Pediatrics Department - Fundacion Jiménez Diaz, Universidad Autonoma de Madrid, Spain. rmoreno@fjd.es
Insights
Hepatitis C virus (HCV) infection in children is mostly acquired vertically, with a 5% transmission risk. Chronic HCV in children presents with milder symptoms but requires long-term follow-up and further treatment studies.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Virology
Background:
- Hepatitis C virus (HCV) infection is uncommon in children, with blood transfusions historically being the primary transmission route.
- Vertical (perinatal) transmission of HCV is increasingly recognized as a significant mode of acquisition in pediatric populations.
- Maternal HIV co-infection and high viral load increase the risk of vertical HCV transmission.
Purpose of the Study:
- To summarize the current understanding of hepatitis C virus infection in children.
- To review the epidemiology, transmission, diagnosis, natural history, and treatment of pediatric HCV.
- To highlight the need for further research in pediatric HCV management.
Main Methods:
- Review of existing literature on pediatric hepatitis C virus infection.
- Analysis of diagnostic criteria for perinatal HCV transmission.
- Evaluation of the natural history and treatment outcomes in children with HCV.
Main Results:
- Vertical transmission accounts for a significant proportion of childhood HCV cases, with an overall risk of approximately 5%.
- Diagnosis requires HCV-RNA detection, as maternal antibodies can persist up to 18 months.
- Chronic HCV in children typically exhibits lower ALT levels and viral loads, with milder liver histology compared to adults.
- Treatment with interferon shows a sustained response in about 40% of pediatric cases.
Conclusions:
- Vertical transmission is a key route for pediatric HCV, necessitating accurate diagnostic approaches.
- The natural history of HCV in children is characterized by slower progression but chronicity remains common.
- Limited treatment data underscores the need for long-term follow-up and multicenter studies to optimize anti-viral therapy efficacy in childhood.
Abstract:
The prevalence of hepatitis C virus (HCV) infection is relatively low in childhood, with anti-HCV prevalence rates of 0.1-0.4% in the Western world. To date, blood transfusion has been the principal route of acquisition of HCV in children, but there is evidence that vertical transmission is overtaking it. The overall risk of vertical perinatal transmission of HCV is about 5%, although it increases with HIV co-infection and higher maternal viraemia. The mode of delivery and breastfeeding do not seem to affect the vertical transmission of HCV. Diagnosis of perinatal transmission relies on determination of ALT levels and the presence of HCV after the second month, while maternal anti-HCV antibodies may persist until 18 months of life. After infancy, a variable percentage of perinatally infected children are anti-HCV negative; thus, detection of HCV-RNA is necessary for accurate diagnosis. The natural history of HCV in childhood is not well understood and the outcome depends on host and viral factors. The rate of progression to chronicity is about 60-80% in both post-transfusion and vertically acquired HCV infection. Compared with adult patients, chronic hepatitis C in children is characterized by both low ALT levels and low viral load, as well as by the mildest histological and immunohistochemical forms of chronic hepatitis. The prognosis is usually worse in multitransfused, thalassaemic children and those who have had cancer. Experience of treatment of chronic hepatitis C in children is limited, with about 40% having a sustained response to the interferon therapy. It is necessary to perform long-term follow-up and multicentre treatment studies to improve knowledge of the natural history of HCV in children, as well as that of the efficacy of anti-viral therapy in childhood.