HEPATITIS C virus (HCV) infection during the perinatal period leads to the earlier development of cirrhosis, suggests new research from Birmingham Children’s Hospital, Birmingham, UK. The study reveals the importance of early HCV screening, so that the effective HCV treatments in the hepatology armamentarium can be used effectively before the early development of cirrhosis. “Early treatment, especially before development of cirrhosis, significantly decreases morbidity and mortality associated with HCV infection,” explained Dr Line Modin, Birmingham Children’s Hospital.
The retrospective review assessed 1,049 patients who were first infected with HCV between birth and 18 years of age. These patients were infected as a result of intravenous drug use (53%), receiving infected blood products (24%), perinatal exposure (11%), and from an unknown cause (11%); the median age of diagnosis was at age 2 for the perinatal group and 19–24 years of age for the remaining groups.
In total, 334 patients had received a diagnosis of cirrhosis at the time of the review, with male sex and heavy alcohol use both found to be significant risk factors correlating with the development of cirrhosis (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2–2.2 and OR: 1.6; 95% CI: 1.2–2.8, respectively); however, it was noted that these risk factors had a low prevalence in the perinatal group.
The median age of cirrhosis diagnosis was lower in the perinatal infection group compared to all other groups (36 years [range: 17–53] versus 48 years [range: 33–68) in the intravenously infected group, 46 years [range: 12–61] in the blood product group, and 51 years [range: 12–65] in the group of unknown cause; p<0.001).
Direct-acting antivirals have greatly improved the treatment of HCV, but the limited availability of related data from clinical trials in children means that paediatric use of these drugs is limited. The researchers hope this study will heighten healthcare providers awareness of childhood HCV: “we recommend that healthcare workers are aware of the prevalence of HCV in childhood, particularly in young adolescents, and that testing according to National Institute for Health and Care Excellence (NICE) guidelines are implemented and treatment is made available,” concluded Dr Modin.