Long-term outcome of vertically acquired and post-transfusion hepatitis C infection in children

Abstract

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. © 2004 Blackwell Publishing Asia Pty Ltd.