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Hepatitis C infection in children: a Melbourne perspective
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Hepatitis C virus (HCV) infection in children is often asymptomatic but can cause ongoing liver damage. Regular follow-up is crucial due to long-term risks like cirrhosis.
Area of Science:
- Hepatology
- Pediatric Infectious Diseases
- Virology
Background:
- Hepatitis C virus (HCV) infection in children presents a unique clinical challenge.
- Understanding the spectrum of pediatric HCV is essential for effective management.
Purpose of the Study:
- To characterize the clinical presentation of HCV infection in children.
- To identify modes of transmission, co-infections, and treatment outcomes.
- To assess biochemical evidence of persistent hepatitis in pediatric patients.
Main Methods:
- Retrospective review of medical records of children with detected HCV antibodies.
- Data extraction included clinical information, investigations, and treatment results.
- Analysis of antibody status, viral RNA, liver enzyme levels, and co-infections.
Main Results:
- HCV infection in children is frequently asymptomatic at presentation.
- Blood product transfusion was the primary mode of acquisition (79%).
- HCV-RNA was detected in 66% of tested children, with 67% showing abnormal ALT levels.
- Hepatitis B virus or HIV co-infections occurred in 12% of cases.
Conclusions:
- Pediatric HCV infection often presents asymptomatically but is associated with biochemical evidence of liver damage.
- Children with HCV are a high-risk group due to the chronic nature of the infection.
- Regular monitoring and follow-up are recommended for children with HCV infection to mitigate long-term risks.
Objective:
To examine the clinical spectrum of hepatitis C virus (HCV) infected children in our care by determining presentation, mode of acquisition, degree of co-infection, biochemical evidence of persisting hepatitis and treatment outcome.
Methodology:
A retrospective review of the medical records of all children attending the Royal Children's Hospital, Melbourne, between 1990 and 1998, who had antibodies to HCV infection detected. Detailed clinical information, investigations and the results of treatment were extracted from the clinical notes.
Results:
A total of 94 children (age range 2 weeks to 19.7 years) were identified, of whom nine had passive transfer of maternal antibodies from HCV-positive mothers and were excluded from analysis. Sixty-seven children (79%) were infected by transfusion of blood or blood products. Perinatal transmission occurred in 11 children (13%), and six children (7%) had a history of i.v. drug abuse. The majority of children were asymptomatic at presentation. Of the 65 patients tested for HCV-ribonucleic acid, 43 (66%) were positive. Fifty-seven cases had serial alanine aminotransaminase (ALT) measurements over a mean of 28 months. Of these, 38 (67%) had an abnormal ALT. Ten cases (12%) were co-infected with hepatitis B virus, HIV or both. Of 12 patients treated with interferon, four responded with normalisation of ALT from 3 to 12 months post-commencement of therapy.
Conclusions:
Although HCV was largely an asymptomatic condition in our clinic population, more than half the patients had biochemical evidence of ongoing liver damage. Given the chronicity of this infection in the majority of patients and the long-term risks of cirrhosis and hepatocellular carcinoma, children with HCV infection represent a high-risk group worthy of regular follow up.