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Perinatal HCV leads to earlier cirrhosis than other pediatric risk groups

Results from a retrospective review of patients infected with hepatitis C in childhood revealed that those with perinatal infection developed cirrhosis earlier than other risk groups, according to a recently published study.

“HCV infection in childhood causes serious long-term liver disease ... which can now be prevented with antiviral therapy,” Line Modin, MD, PhD, from the Birmingham Women’s and Children’s Hospital in the United Kingdom, and colleagues wrote. “Early treatment, especially before development of cirrhosis, significantly decreases morbidity and mortality associated with HCV infection.”

The review comprised 1,049 patients whose first infection occurred between birth and age 18 years. Routes of infection included intravenous drug use (53%), receipt of infected blood products (24%), perinatal exposure (11%), and an unknown cause (11%).

Median time between HCV infection and diagnosis was between 19 years and 24 years for the intravenous drug group, the blood product group, and the unknown risk group, compared with 2 years for the perinatal group.

Overall, 334 patients received a diagnosis of cirrhosis at the time of the review. Significant risk factors correlated with the development of cirrhosis included male sex (OR = 1.6; 95% CI, 1.2-2.2) and heavy alcohol use (OR = 1.6; 95% CI, 1.2-2.8).

Patients with perinatal infection developed cirrhosis earlier at a median age of 36 years (range, 17-53 years), compared with 48 years (range, 33-68 years) in the intravenous drug group, 46 years (range, 12-61 years) in the blood product group, and 51.5 years (range, 12-65 years) in the unknown risk group (P < .001).

The researchers noted that cirrhosis developed in the perinatal group despite a low prevalence of the correlated male sex and heavy alcohol use risk factors compared with the intravenous drug group.

Among 502 patients with full data including HCV treatment and follow-up, 87 patients experienced disease progression, which was more common in those with cirrhosis than those without cirrhosis (28% vs. 13%; P < .001). Additionally, progression to hepatocellular carcinoma, liver transplant or death was almost exclusive to patients who had cirrhosis at the time of HCV treatment.

“Currently, access to clinical trials of DAAs in childhood is limited which denies timely access to effective therapies for young infected children,” Modin and colleagues wrote. “We recommend that health care workers are aware of the prevalence of HCV in childhood, particularly in young adolescents, and that testing according to NICE guidelines are implemented and treatment is made available.” – by Talitha Bennett

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