https://www.ncbi.nlm.nih.gov/pubmed/30496763 Hepatitis C

J Hepatol. 2018 Nov 26. pii: S0168-8278(18)32545-5. doi: 10.1016/j.jhep.2018.11.013. [Epub ahead of print]
Epidemiology and natural history of hepatitis C virus infection among children and young people.
Modin L1, Arshad A2, Wilkes B3, Benselin J3, Lloyd C2, Irving WL3, Kelly DA2.

Abstract

BACKGROUND:
Chronic hepatitis C virus (HCV) infection is a global health burden. Although HCV infection rarely contributes to morbidity during childhood, the majority of HCV infected children develop chronic HCV with a lifetime risk of liver disease. Little is known about the development of long-term liver disease and treatment effect in patients infected with HCV in childhood.

METHOD:
Retrospective review of patients infected with HCV in childhood enrolled in HCV Research UK.

RESULTS:
1049 patients were identified. The main routes of infection were intravenous drug use (53%); blood product exposure (24%); perinatal infection (11%). Liver disease developed in 32% of patients at a median of 33 years irrespective of mode of infection. Therefore, patients with perinatal exposure developed cirrhosis at an earlier age than the rest of the risk groups. Incidence of hepatocellular carcinoma (HCC) was 5%, liver transplant 4% and death occurred in 3%. Overall, 663 patients were treated (interferon/Peg interferon; 55% or direct acting antivirals; 40%). Sustained virological response (SVR) was achieved in 406 (75%). There was higher mortality among patients without SVR vs SVR (5% vs 1%, p=0.003). Treatment was more effective in those without cirrhosis and disease progression was less (13%), compared to those patients with cirrhosis at the time of therapy (28%) p<0.001, who were more likely to develop HCC, require liver transplantation, or die.

CONCLUSION:
HCV infection in young people causes significant liver disease, which can now be prevented with antiviral therapy. Early treatment, especially before development of cirrhosis is essential. Detection of HCV should be aimed at relevant risk groups and anti-viral therapy should be made available in childhood to prevent long-term liver disease and spread of HCV.

LAY SUMMARY:
Chronic HCV infection is a global health problem, which can now be treated with potent directly acting antiviral drugs. This study demonstrates (i) HCV infection in childhood causes serious liver disease in 32% of patients at a median of 33 years, irrespective of age, mode and route of infection (ii), the commonest routes of infection in those under 18 years of age in the UK are intravenous drug use (53%), via blood or blood products (24%) and via perinatal transmission (11%); (iii) disease outcome was better in patients treated before the development of advanced liver disease. Anti -viral therapy should be made available in childhood to prevent long-term liver disease and spread of HCV.