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A Protocol for Analyzing Hepatitis C Virus Replication
Published on: June 26, 2014
Hepatitis C in children: a quaternary referral center perspective
Carolina Rumbo1, Rima L Fawaz, Sukru H Emre
1Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
Insights
Chronic hepatitis C virus (HCV) infection in children can progress rapidly, leading to cirrhosis and poor transplant outcomes. Eradicating HCV before liver transplantation is crucial for better long-term results.
Area of Science:
- Pediatric Hepatology
- Viral Immunology
Background:
- Chronic hepatitis C virus (HCV) infection impacts 0.3% of US children, often perceived as having a benign childhood course.
- This study examines a pediatric cohort with chronic HCV at a quaternary referral center.
Observation:
- A retrospective review included 91 pediatric patients (mean age 9 years; 52% female) with chronic HCV.
- Genotype 1 was prevalent (83%). Twenty-one patients received interferon and ribavirin therapy.
- Sustained viral response was achieved in 53% of 15 patients completing therapy. Seven patients presented with cirrhosis, four underwent liver transplantation with universal HCV recurrence and poor outcomes.
Findings:
- While generally slow-progressing, chronic HCV in children can accelerate, causing early cirrhosis and necessitating liver transplantation.
- Hepatitis C virus universally recurs post-transplant, with a generally poor prognosis.
Implications:
- Early HCV eradication before liver transplantation offers the most promising long-term strategy for pediatric patients.
- This highlights the need for effective pediatric HCV treatment protocols and vigilant post-transplant monitoring.
Introduction:
Chronic hepatitis C virus (HCV) infection affects 0.3% of children in the United States, and the general impression is that it has a benign course in childhood. We analyzed a pediatric population with chronic HCV in a quaternary referral center.
Material And Methods:
This is a retrospective clinical review comprising all patients with chronic HCV referred to the Pediatric Liver/Liver Transplant Program between January 1999 and December 2004.
Results:
Ninety-one patients (52% female; mean age, 9 years) were assessed. Eight-three percent of the patients were genotype 1. Twenty-one patients received/are receiving interferon and ribavirin for chronic HCV (treatment indications--advanced disease, 9; clinical trial, 6; genotype 2, 2; social, 2; prerenal transplant, 1). Eight (53%) of 15 patients, who have completed therapy and follow-up, achieved sustained viral response. Seven of 91 patients had cirrhosis at presentation (mean age, 11.7 years). Four underwent liver transplantation, all experienced HCV recurrence, 2 died, 1 was retransplanted, and 1 has compensated cirrhosis.
Conclusion:
Although, in general, HCV in children has a slow progression, there are cases with an accelerated course and early development of cirrhosis requiring liver transplant. Hepatitis C virus recurs universally after transplant, and its prognosis is usually poor; therefore, the most promising long-term approach is to clear this infection before transplantation.
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