Pathology of Chronic Hepatitis C in Children: Peds-C Trial

While the natural history of chronic hepatitis C virus (HCV) infection has been well studied in adults, less is known about how the disease progresses in children.

In an analysis described in the March 2008 issue of Hepatology, investigators evaluated liver histopathology among children with chronic hepatitis C participating in the Peds-C trial, which assessed the safety and efficacy of pegylated interferon alfa-2a (Pegasys) plus ribavirin in pediatric patients.

The present analysis involved liver biopsies from 121 previously untreated children ages 2 to 16 years (mean 9.8 years). Participants had no other identifiable causes of liver disease besides HCV infection, no signs of hepatic decompensation, and no other significant non-hepatic disease. Liver biopsies were scored for inflammation, fibrosis, steatosis (fat accumulation), and other histological features.

Results

• Liver inflammation was minimal in 42% of the biopsy samples, mild in 17%, moderate in 38%, and severe in 3%.

• 5 patients had bridging fibrosis and 2 had cirrhosis.

• 56% of samples showed no liver steatosis, 34% showed minimal steatosis, and 10% showed mild steatosis; there were no cases of moderate or severe steatosis.

• Inflammation scores correlated with fibrosis scores, serum alanine aminotransferase (ALT) levels, and duration of HCV infection.

• However, inflammation was not associated with patient age, body mass index (BMI), or HCV genotype.

• Fibrosis scores correlated with inflammation, but not with age, HCV genotype, BMI, or steatosis.

• Steatosis correlated with ALT levels and BMI, with overweight children having more fibrosis than those who were not overweight.

Conclusion

In conclusion, the authors wrote, "in this cohort of HCV-infected children, inflammation, fibrosis, and steatosis were milder than reported for treatment-naive adults with chronic hepatitis C, but there were several with bridging fibrosis or cirrhosis."

They added that, "The positive correlation of inflammation with duration of infection and fibrosis, and of obesity with fibrosis suggest that children with chronic hepatitis C will be at risk for progressive liver disease as they age and possibly acquire other comorbid risk factors."


ZD Goodman, HR Makhlouf, L Liu, and others. Pathology of chronic hepatitis C in children: Liver biopsy findings in the Peds-C Trial. Hepatology 47(3): 836-843. March 2008.