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Natural history of perinatal hepatitis C virus infection
E Palomba1, P Manzini, P Fiammengo
1Department of Pediatrics, University of Turin, Italy.
Insights
Perinatal Hepatitis C Virus (HCV) infection in children rarely resolves naturally. Most children remain viremic and develop chronic liver inflammation, indicating a poor prognosis for spontaneous clearance.
Area of Science:
- Hepatology
- Virology
- Pediatrics
Background:
- Perinatal Hepatitis C Virus (HCV) infection is a significant concern.
- Understanding the long-term outcomes of vertically transmitted HCV is crucial for pediatric care.
Purpose of the Study:
- To prospectively investigate the natural course of perinatal Hepatitis C Virus (HCV) infection in children.
- To assess the long-term viral persistence, liver inflammation, and clinical outcomes in this cohort.
Main Methods:
- Prospective follow-up of seven children with perinatal HCV infection for a mean of 65.1 months.
- Regular monitoring of physical examinations, growth, liver function tests (ALT), immunoglobulin levels, HCV-RNA, and autoantibodies.
- Liver biopsies were performed on five patients to assess histological changes.
Main Results:
- All seven children remained viremic throughout the follow-up period.
- Initial elevations in alanine aminotransferase (ALT) normalized or became borderline in most, but two experienced exacerbations.
- Liver biopsies revealed varying degrees of chronic persistent hepatitis in all assessed patients.
- IgM antibodies to HCV were detected in three children, and autoantibodies developed in two.
Conclusions:
- Spontaneous clearance of perinatal Hepatitis C Virus (HCV) infection appears unlikely in children.
- The majority of children with perinatal HCV infection develop chronic hepatitis, even with intermittent normalization of liver enzymes.
- Long-term viremia and histological liver damage are common sequelae of perinatal HCV infection.
Abstract:
In order to outline the natural course of perinatal hepatitis C virus (HCV) infection, we prospectively followed seven HCV-positive children for a mean period of 65.1 months (range, 26-90 months). Physical examination findings, growth, and bilirubin and immunoglobulin levels were constantly normal. All children were still viremic at last analysis. HCV-RNA was almost constantly detected throughout follow-up, with the exception of the first days of life. All children had initial increases (of variable duration) in alanine aminotransferase values: four children subsequently had normal or borderline values for years, with exacerbation of inflammatory activity in two cases. IgM antibodies to HCV were found in three of the seven patients. Autoantibodies developed in two children. Liver biopsy, performed on five patients, documented different degrees of chronic persistent hepatitis. Thus, recovery from perinatal HCV infection seems unlikely, and chronic hepatitis develops in most infected children, including those with prolonged intervals of remission of inflammatory activity.