Abstract
SummaryRussia has one of the highest prevalences of paediatric chronic hepatitis C infection (CHC). Our aim was to provide a detailed characterization of children and adolescents with CHC including treatment outcomes. Thus, an observational study of children with CHC aged <18 years was conducted in three hepatology centres from November 2014 to May 2017. Of 301 children (52% male), 196 (65%) acquired HCV vertically, 70 (23%) had a history of blood transfusion or invasive procedures, 1 injecting drug use and 34 (11%) had no known risk factors. Median age at HCV diagnosis was 3.1 [interquartile range, IQR 1.1, 8.2] and 10.8 [7.4, 14.7] at last follow‐up. The most common genotype was 1b (51%), followed by 3 (37%). Over a quarter of patients (84, 28%) had raised liver transaminases. Of 92 with liver biopsy, 38 (41%) had bridging fibrosis (median age 10.4 [7.1, 14.1]). Of 223 evaluated by transient elastography, 67 (30%) had liver stiffness ≥5.0 kPa. For each year, increase in age mean stiffness increased by 0.09 kPa (95% CI 0.05, 0.13, P < 0.001). There was significant correlation between liver stiffness and biopsy results (Tau‐b = 0.29, P = 0.042). Of 205 treated with IFN‐based regimens, 100 (49%) had SVR24. Most children (191, 93%) experienced adverse reactions, leading to treatment discontinuation in 6 (3%). In conclusion, a third of children acquired HCV via nonvertical routes and a substantial proportion of those with liver biopsy had advanced liver disease. Only half of children achieved SVR24 with IFN‐based regimens highlighting the need for more effective and better‐tolerated treatments with direct‐acting antivirals. Further studies are warranted in Russia on causes and prevention of nonvertical transmission of HCV in children.
Highlights
Chronic hepatitis C (CHC) remains one of the major causes of cirrhosis, hepatocellular carcinoma and end-stage liver disease worldwide
The World Health Organization (WHO) estimates that there are 71 million people living with hepatitis C virus (HCV) infection, accounting for 1% of the global population; only 20% of those infected know about their diagnosis
In 2013, a CHC prevalence of 336 per 100 000 population was reported in the HCV national surveillance system, reaching 670 per 100 000 in some regions; overall CHC incidence was 40 per 100 000 per year but varied widely across regions, from 13 to 68.6 Over the last few years, the reported CHC incidence has gradually decreased to 35-36 per 100 000 in 2016-2017.7 Genotype (GT) 1b is the most prevalent genotype accounting for 55% of all cases, followed by GT3 (35%).[8]
Summary
Chronic hepatitis C (CHC) remains one of the major causes of cirrhosis, hepatocellular carcinoma and end-stage liver disease worldwide. The World Health Organization (WHO) estimates that there are 71 million people living with hepatitis C virus (HCV) infection (based on HCV viraemia data), accounting for 1% of the global population; only 20% of those infected know about their diagnosis. Of those who are chronically infected, 15%-30% progress to cirrhosis in 20 years and 399 000 people die annually.[3,4] The WHO European region, which includes the whole of Europe and Central Asia, is one of the most affected global regions with an estimated chronic HCV infection prevalence of 1.5% and incidence of 62 per 100 000 population per year.[4] Reliable paediatric estimates are lacking, as HCV infection in children remains largely undiagnosed. In 2013, a CHC prevalence of 336 per 100 000 population was reported in the HCV national surveillance system, reaching 670 per 100 000 in some regions; overall CHC incidence was 40 per 100 000 per year but varied widely across regions, from 13 to 68.6 Over the last few years, the reported CHC incidence has gradually decreased to 35-36 per 100 000 in 2016-2017.7 Genotype (GT) 1b is the most prevalent genotype accounting for 55% of all cases, followed by GT3 (35%).[8]
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