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Clinical picture of chronic hepatitis C in children--Polish experience
E Majda-Stanisławska1, A Omulecka, I Szaflik
1Department of Infectious Diseases, Medical University of Lodz 91-347 Lodz, ul. Kniaziewicza 1/3, Poland.
Insights
Long-term hepatitis C virus (HCV) infection in children shows varied outcomes. Neonatal infections were linked to less severe liver fibrosis, while elevated ALT levels correlated with inflammation and fibrosis stages.
Area of Science:
- Pediatrics
- Hepatology
- Virology
Background:
- Hepatitis C virus (HCV) infection in children presents unique challenges for long-term management and outcome assessment.
- Understanding the clinical, virologic, and histologic progression of pediatric HCV is crucial for effective intervention.
Purpose of the Study:
- To investigate the long-term clinical, virologic, and histologic outcomes of hepatitis C virus infection in a cohort of children.
- To identify factors influencing disease progression, including age at infection and biochemical markers.
Main Methods:
- A longitudinal study followed 60 children with HCV for 1-5 years, monitoring HCV RNA, anti-HCV, and ALT levels.
- Liver biopsy specimens were assessed for inflammation (grading) and fibrosis (staging) using a 0-4 scale.
- Statistical analyses explored correlations between clinical parameters, biochemical markers, and histopathologic findings.
Main Results:
- HCV infection duration ranged from 1-16 years. Neonatal infections (n=25) showed significantly lower fibrosis staging scores compared to later infections (n=24).
- Elevated ALT levels (>105 U/l) were observed in 18% of children, with significant correlations between ALT, AST, GGT levels and liver inflammation/fibrosis grading and staging.
- Histopathology revealed mild-to-moderate inflammation in 87% of children; 5% were diagnosed with liver cirrhosis.
Conclusions:
- Pediatric HCV infection outcomes vary, with neonatal infections potentially having a less severe fibrotic course.
- Biochemical markers like ALT, AST, and GGT correlate with liver damage severity in children with HCV.
- Long-term monitoring and histopathologic evaluation are essential for managing pediatric hepatitis C.
Abstract:
The aim of this study was to investigate long-term clinical, virologic and histologic outcome of hepatitis C virus infection in children. Sixty children (16 girls and 44 boys) have been followed for 1 to 5 years (mean 1.7 +/- 0.9 years). HCV RNA and anti-HCV were checked every six months. Biopsy specimens were evaluated for the grade of inflammation and stage of fibrosis (scores 0-4). ALT was measured every 3 months. Presumed duration of HCV infection was from 1 to 16 years (mean 7.4 +/- 3 years). Fifteen (25%) children could have been infected by blood transfusion, 5 (8%) during surgical procedures, 29 (50%) were multiply hospitalized. Twenty-five children infected as neonates had lower staging score than 24 infected later in life (p = 0.021). Two girls (aged 13 and 14) were diagnosed with acute hepatitis C, with maximum ALT of 1272 U/l and 1638 U/l respectively. In 11 children (18%) median ALT of more than 3 times the normal value (> 105 U/l) was noted. Six children (10%) had continuously normal ALT. Histopathology revealed mild to moderate inflammatory activity (0-2 points) in 52 children (87%). Seven specimens (11%) were scored for 3 to 4 staging points, 3 of them (5%) were diagnosed with liver cirrhosis. We have found statistically significant correlation between median ALT and grading (r = 0.36; p = 0.005) as well as staging scores (r = 0.32; p = 0.016), median AST and grading (r = 0.36; p = 0.006) as well as staging (r = 0.36; p = 0.007) scores but also median GGT and staging score (r = 0.39; p = 0.004).