LIVER PATHOLOGY IN A COHORT OF HEPATITIS C VIRUS (HCV) INFECTED CHILDREN

Abstract

202 Aims: To evaluate the severity of HCV infection among pediatric patients and the association of liver histology with duration of infection and route of transmission. Methods: 33 patients, 1-27 years of age (mean 10.9 years), were referred to the JHH Pediatric Liver Center and assessed by liver biopsy and concurrent serum alanine aminotransferase(ALT). HCV-RNA was detected by RT-PCR. HCV genotype was assessed by restriction fragment length polymorphism. The liver collagen (LC) content was measured by Fast green/Sirius Red which has been shown by Jimenez et al. [Hepatology 1985;5(5):815-818] to correlate directly with the degree of morphometric fibrosis. Liver biopsies were assigned mean Histology Activity Index (HAI) scores by two blinded pathologists according to Knodell criteria[Hepatology 1981; 1(6):431-5]. Results: The mean HAI score was 6±0.6 (range 1-20, mean fibrosis subscore= 1.2), and 68% had mild chronic hepatitis (HAI= 0.5-6), 25% had chronic active hepatitis (HAI=7-12), and 7% had cirrhosis. The children with hemophilia had less liver injury than those with infection after other exposures (no exposure could be identified for two children): TableThe mean duration of infection was 8.2 years (n=19, range 1-19). ALT and HAI were highly correlated (p<0.001. r=0.7). No significant correlation was detected between duration of infection and HAI (r2=0.14, p=0.096), duration of infection and ALT (r2=0.14), or age and HAI(r2=0.08). Mean HAI scores were similar for each HCV subtype as follows: 6 for 1a (n=11), 5 for 1b (n=7), 10 for 2b (n=1), 2 for indeterminate(n=1). The LC values in the HCV infected children (n=24) were 89 ± 4μg/mg total protein, similar to teenage controls (86 ±4, n=9). There was no relationship between HAI and LC. Conclusions: 1) During childhood. HCV infection causes portal and lobular inflammation, generally without fibrosis. 2) In this series, there was less severe inflammation among the hemophiliacs. but no association with duration of infection. This finding may reflect more frequent detection of asymptomatic infection through screening of hemophiliacs. 3) In children with HCV infection, there is no simple relationship between duration of infection and disease progression and rapid progression to cirrhosis may occur. Particular host and viral factors may be more important in progression of childhood HCV infection than total duration of infection.