Long-term course of chronic hepatitis C in children: from viral clearance to end-stage liver disease

BACKGROUNG & AIMS: The natural course of chronic hepatitis C (CHC) in children is not well understood. The aim of this study was to assess th elong-term course of CHC in a large sample of otherwise healthy children.
METHODS: From 1990 to 2005, 504 consecutive antihepatitis C virus (HCV)-positive children were enrolled at 12 centers of a national observatory and were followed up retrospectively/prospectively.
RESULTS: Putative exposure was perinatal in 283 (56.2%) cases, parenteral in 158 (31.1%), and unknown in 63 (12.5%). At baseline, 477 (94.6%) cases were HCV RNA seropositive, 118 (24.7%) of which were treated with standard interferon Alpha. Ten years after putative exposure, the outcome in 359 HCR RNA-positive, untreated patients was (1) undetectable viremia in 27 (7.5%) (by Cox regression analysis, spontaneous viral clearance was independently predicted by genotype 3 (hazard ratio 6.44; 95% confidence interval: 2.7-15.5) and (2) persistent viremia in 332 (92%) cases. Six of these 332 cases (1.8%) progressed to decompensated cirrhosis (mean age, 9.6 years). This latter Group included 5 Italian children perinatally infected with genotype 1a (4 of the mothers were drug users). Thirthy-three (27.9%) treated patients achieved a sustained virologic response.
CONCLUSIONS: Over the course of a decade, few children with chronic HCV infection cleared viremia spontaneously, and those who did were more likely to have genotype 3. Persistent viral replication led to end-stage liver disease in a small subgroup characerized by perinatal exposure, maternal drug use, and infection with HCV genotype 1a. Children with such features shoud be considered for early treatment.