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Pathology of chronic hepatitis C in children: Liver biopsy findings in the Peds‐C Trial
Author(s) -
Goodman Zachary D.,
Makhlouf Hala R.,
Liu Lea,
Balistreri William,
GonzalezPeralta Regino P.,
Haber Barbara,
Jonas Maureen M.,
Mohan Parvathi,
Molleston Jean P.,
Murray Karen F.,
Narkewicz Michael R.,
Rosenthal Philip,
Smith Lesley J.,
Robuck Patricia R.,
Schwarz Kathleen B.
Publication year - 2008
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.22094
Subject(s) - steatosis , medicine , gastroenterology , fibrosis , cirrhosis , liver biopsy , body mass index , hepatitis c , inflammation , biopsy , pathology
There is relatively little information in the literature on the histopathology of chronic hepatitis C in children. The Peds‐C Trial, designed to test the efficacy and safety of peginterferon alfa‐2a and ribavirin in children, provided an opportunity to examine liver biopsies from 121 treatment‐naïve children, ages 2 to 16 (mean, 9.8 years) infected with the hepatitis C virus (HCV) and with no other identifiable cause for liver disease, signs of hepatic decompensation, or another significant nonhepatic disease. Liver biopsies were scored for inflammation, fibrosis, steatosis, and other histological features. Inflammation in the biopsy was minimal in 42%, mild in 17%, moderate in 38%, and severe in only 3%. Five had bridging fibrosis, and 2 had cirrhosis. Steatosis was absent in 56%, minimal in 34%, and mild in 10%. Inflammation scores correlated with fibrosis scores, serum alanine aminotransferase levels, and duration of infection, but not with age, body mass index z score, or HCV genotype. Fibrosis scores correlated with inflammation but not with age, HCV genotype, body mass index z score, or steatosis parameters. Steatosis correlated with serum alanine aminotransferase levels and body mass index z scores; overweight children had more fibrosis than the non‐overweight. In conclusion, in this cohort of HCV‐infected children, inflammation, fibrosis, and steatosis were milder than reported for treatment‐naïve adults with chronic hepatitis C, but there were several with bridging fibrosis or cirrhosis. The positive correlation of inflammation with duration of infection and fibrosis and of obesity with fibrosis suggest that children with chronic hepatitis C will be at risk for progressive liver disease as they age and possibly acquire other comorbid risk factors. (H EPATOLOGY 2007.)