Abstract
Hepatitis C virus (HCV) infection has been associated with autoimmunity and extrahepatic manifestations in adults. Few data are available on these topics in children. Nonorgan specific auto-antibodies development is part of the natural course of chronic hepatitis C in children. Smooth muscle autoantibody is the most common autoantibody found, while liver-kidney microsomal type-1 antibody positivity is the most peculiar autoimmune feature of children with HCV infection. The clinical significance of non-organ specific autoantibodies in the course of paediatric chronic hepatitis C is still debated. Autoantibody positivity can be considered neutral for most patients, while it can be associated with negative connotations for others, especially those positive for liver-kidney microsomal type-1 autoantibody. Subclinical hypothyroidism but not autoimmune thyroiditis has been demonstrated in HCV infection in children, while only few cases of HCV-associated membranoproliferative glomerulonephritis have been described. Single reports are available in the literature reporting the anecdotal association between chronic hepatitis C and other extrahepatic manifestations such as myopathy and opsoclonus-myoclonus syndrome. Despite the low incidence of extrahepatic manifestations of chronic hepatitis C in children, overall, available data suggest a careful monitoring.
Highlights
Since its discovery in 1989 [1], hepatitis C virus (HCV) has been associated with autoimmunity and extrahepatic manifestations [2]
About one third of the children studied had circulating Nonorgan Specific AutoantibodiesNonorgan specific autoantibodies (NOSAs) smooth muscle autoantibody (SMA) being the most common autoantibody found. In this cohort, patients with liver-kidney microsomal type1 (LKM-1) autoantibody were more often infected by HCV genotypes 1 and 2, while no difference was found between autoantibodies positive and negative cases with respect to clinical features, γ-globulins levels, and liver histology
This hypothesis is supported by the observation that different children despite NOSAs presence and persistence have normal serum aminotransferase level, will not develop other features of autoimmunity such as increased γ-globulins levels, and usually have autoantibodies titres lower than that observed in autoimmune hepatitis (AIH) and with a different pattern as detected by indirect immunofluorescence [3,4,5]
Summary
Since its discovery in 1989 [1], hepatitis C virus (HCV) has been associated with autoimmunity and extrahepatic manifestations [2]. Data on these topics in children are scarce, but the incidence of extrahepatic manifestations is overall lower in children with chronic hepatitis C when compared to adults [2,3,4,5,6]. The purpose of the present article is to summarize the current knowledge on autoimmunity and extrahepatic manifestations in treatment-naıve children with chronic HCV infection
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