Chronic hepatitis c virus infection in childhood: Clinical patterns and evolution in 224 white children

The characteristics and evolution of hepatitis C virus (HCV) infection were retrospectively investigated in a study of 224 HCV RNA-seropositive white children who were consecutively recruited at 7 European centers in 1980-1998. At presentation, all patients were positive for antibodies to hepatitis C virus, 87% were asymptomatic, and 48% had alanine aminotransferase (ALT) levels that were less than or equal to2 times the upper limit of the range considered to be normal. Of 200 children followed for 1-17.5 years (mean follow-up +/- standard deviation [SD], 6.2 +/- 4.7 years), only 12 (6%) achieved sustained viremia clearance and normalization of the ALT level In 92 revised liver biopsy specimen analyses, the mean fibrosis score (+/-SD) was 1.5 +/- 1.3 for children <15 years of age and 2.3 +/- 1.2 for children >= 15 years of age (range, 0-6 years; P < .01). Pediatric HCV infection is usually mild, but few patients, especially those who are perinatally infected, clear viremia in the medium-term follow-up. Conversely, the higher rates of fibrosis observed in older patients suggest the possibility of an insidious progression of HCV-associated liver disease.