November 22, 2013

Progression of Liver Disease in Children with Chronic HCV Infection

Provided by NEJM Journal Watch

November 21, 2013

Atif Zaman, MD, MPH reviewing Mohan P et al. Hepatology 2013 Nov.

Histologic changes were slow overall but did include a significant increase in bridging fibrosis or cirrhosis.

The rate of liver disease progression with hepatitis C virus (HCV) infection is well characterized in adults but not in children. Although most study data from Asia and Europe suggest that liver disease progression in children with HCV infection is very slow, data from several U.S. studies indicate that it is still a risk.

In the current retrospective study, investigators compared histologic findings from repeat biopsies in 44 treatment-naive children with HCV infection who were enrolled in a larger randomized treatment trial. Data were from two biopsies taken at least 1 year apart (mean time interval, 5.8±3.5 years). HCV infection was contracted via vertical transmission in 57% of children and via blood transfusion in the rest (except for 2 participants with unknown mode of transmission). The prevalence of genotype 1 infection was 84%.

Analyses of the repeat biopsies showed the following:

  • Persistent minimal inflammation in 50% of patients

  • Persistent absence of fibrosis in 16% of patients

  • An increase in bridging fibrosis or cirrhosis from 11% to 20% (P=0.005)

  • No correlation between worsening fibrosis and mode of HCV infection acquisition or demographic, clinical, or laboratory variables

Comment

    This is the largest study to date evaluating the histologic progression of hepatitis C virus infection in the pediatric population. In general, histologic progression was quite slow during a 5-year time span in the majority of patients, but, similar to the adult population, a significant minority did have histologic progression. With the advent of more-effective, better-tolerated treatment regimens for HCV infection, considering HCV treatment in the pediatric population will be important, as these patients face many decades of infection and increased risk for histologic progression without treatment.

    Disclosures for Atif Zaman, MD, MPH at time of publication Speaker’s bureau Bristol-Myers Squibb; Genentech; Gilead; Kadmon; Merck; Salix; Vertex

    Citation(s):

    1. Mohan P et al. Evaluating progression of liver disease from repeat liver biopsies in children with chronic hepatitis C: A retrospective study. Hepatology 2013 Nov; 58:1580. (http://dx.doi.org/10.1002/hep.26519)

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