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Long-term outcome of vertically acquired and post-transfusion hepatitis C infection in children
Sanguansak Rerksuppaphol1, Winita Hardikar, Gregory J Dore
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Pediatric hepatitis C virus (HCV) infection acquired perinatally is generally asymptomatic and slowly progressive. Both vertical and transfusion-acquired HCV in children show similar outcomes and viral clearance rates.
Area of Science:
- Pediatric Hepatology
- Virology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection acquired perinatally presents unique challenges in understanding its long-term effects.
- This study retrospectively reviewed clinical and laboratory outcomes in children with HCV infection acquired through blood transfusion (BT) or vertically (VT).
Purpose of the Study:
- To determine the natural history of perinatally acquired hepatitis C virus (HCV) infection in children.
- To compare clinical and laboratory outcomes between infants infected via blood transfusion and those with vertically acquired HCV.
Main Methods:
- Retrospective review of 31 children with HCV infection.
- Evaluation of demographic data, clinical symptoms, liver biochemistry, HCV antibody, HCV-RNA, and liver histology.
Main Results:
- No abnormal clinical findings of chronic liver disease were observed in either group.
- An estimated HCV-RNA clearance rate of 19% was observed, with no significant difference between BT and VT groups.
- Alanine aminotransferase levels were higher in the VT group during the first five years of life; liver biopsies showed mild to moderate fibrosis or necroinflammatory activity, but no cirrhosis.
Conclusions:
- HCV infection acquired in infancy typically results in asymptomatic and slowly progressive disease for the first decade.
- The mode of acquisition (vertical vs. transfusion) has a limited impact on outcomes, including viral clearance and antibody seroreversion.
Background And Aim:
To determine the natural history of perinatally acquired hepatitis C virus (HCV) infection, clinical and laboratory outcomes among 31 children with HCV infection were retrospectively reviewed. Fifteen children had acquired HCV by blood transfusion (BT) prior to 6 months of age and 16 had vertically acquired (VT) HCV.
Methods:
Demographic data, clinical symptoms and signs, liver biochemistry, HCV antibody, HCV-RNA and liver histology were evaluated.
Results:
Mean age at last visit was 13.0 years (range 9.0-16.8 years) in the BT group and 8.6 years (range 0.5-18.1 years) in the VT group. There were no abnormal clinical findings of chronic liver disease in either group. Estimated HCV-RNA clearance rate was 19%, with no significant difference between the groups. In HCV-RNA-negative children (n = 6), two lost anti-HCV antibody and two developed indeterminate anti-HCV antibody results, while all HCV-RNA-positive children (n = 25) remained both anti-HCV antibody positive and HCV-RNA positive throughout follow up. The alanine aminotransferase level was significantly higher in the VT group than in the BT group during the first 5 years of life. Liver biopsy, which was carried out in four children, revealed mild to moderate fibrosis and/or necroinflammatory activity, but no cirrhosis.
Conclusions:
Outcomes among children with HCV acquired in infancy demonstrate asymptomatic and slowly progressive disease, at least for the initial decade of infection. Mode of acquisition appears to have a limited impact on outcomes, with similar viral clearance and anti-HCV antibody seroreversion rates in vertical and transfusion acquired infection.
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