Epidemiology

Three modalities seen in vertically acquired HCV

Last Updated: 2005-06-28 15:59:47 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Between 20% and 25% of children vertically infected with hepatitis C may clear the virus, most by 3 years of age, according to a new study from the European Paediatric Hepatitis C Virus Network.

There also appear to be three categories of infection in these children, similarly to adults, Dr. Marie-Louise Newell of the Institute of Child Health at University College, London and colleagues conclude: those who clear the virus, 50% with chronic, asymptomatic infection, and 30% with chronic, active infection.

The researchers followed 266 children who acquired the virus vertically, from birth up to a median of 4.2 years of age. Children were considered infected based on two or more PCR tests positive for HCV RNA, or a positive test for HCV antibody at 18 months of age or older. Ten percent of the children also were infected with HIV.

One in ten children of the children had hepatomegaly, the only clinical sign of disease seen in the group, the researchers report in the July 1st issue of Clinical Infectious Diseases. Children with abnormally high alanine transaminase (ALT) levels were four times more likely to have hepatomegaly.

The children who had a lower percentage of positive PCR tests were more likely to clear the virus, as were those with a lower percentage of abnormal ALT tests.

The researchers note that their estimated clearance rate is conservative, given that it does not include children who were PCR-negative but antibody positive after 18 months of age.

"Given the long latency time between infection and symptoms of 20 years or greater in adults, the lack of serious clinical manifestations among the children in our study highlights the need to investigate approaches to monitor the long-term consequences of vertically acquired HCV infection," the researchers conclude.

Clin Infect Dis 2005;41:45-51.