Epidemiology

Infants infected with hepatitis C at low risk for progressive liver disease

Last Updated: 2004-01-27 11:02:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Hepatitis C (HCV) infection acquired from neonatal blood transfusions has a relatively benign course for at least 35 years, results of an Italian study suggest, with low rates of disease progression. All viremic cases were associated with the 1b genotype, considered to be the most aggressive.

HCV onset during adulthood is associated with a higher risk of progression to cirrhosis within 20 years than that acquired earlier in life, senior investigator Dr. Alessandro Remo Zanetti and colleagues note in their report, published in the January issue of Hepatology. However, most studies of associated disease progression rarely encompassed more than 20 years of follow-up.

To gain further insight into outcomes of HCV infection, Dr. Zanetti, at the University of Milan and his group identified 31 individuals who, in 1968, had received blood from donors later found to be positive for anti-HCV antibodies. They obtained blood samples from these subjects in 1998, and found that only 18 subjects had anti-HCV antibody, 16 of whom were HCV RNA positive.

Those negative for HCV RNA remained nonviremic during a 5-year prospective follow-up.

"We do not know whether the 13 recipients found to be anti-HCV and HCV RNA negative were resistant to the infection or whether they lost HCV markers over time," the authors write.

There were no cases of cirrhosis. Liver biopsies obtained in 1998 from 11 subjects revealed histologic signs of progressive liver damage in only three individuals. Repeat biopsies five years later in five subjects showed that only one case progressed from absence of fibrosis to mild portal fibrosis.

"Taking into account the limited study sample," the authors conclude, "these findings suggest that HCV infection acquired early in life shows a slow progression and mild outcome during the first 35 years of infection."

Hepatology 2004;39:90-96.