INCIDENCE AND NATURAL-HISTORY OF CHEMICALLY-DEFINED VARICELLA-ZOSTER VIRUS HEPATITIS IN CHILDREN AND ADOLESCENTS

Of 786 children and adolescents enrolled in a multicenter trial of acy clovir for chickenpox, 27 (3.4%) met the case definition of varicella- zoster virus (VZV) hepatitis (serum aspartate aminotransferase level g reater than or equal to 100 U/l). The clinical and cutaneous manifesta tions of chickenpox in the 15 placebo recipients with this complicatio n did not differ significantly from those in 45 matched controls (p > 0.05), indicating that liver involvement by VZV is not a consequence o f more extensive disease. Although acyclovir modified the course of ch ickenpox overall, it did not prevent VZV hepatitis; that is, the propo rtions of affected subjects with liver involvement postenrollment did not differ significantly between the drug and placebo recipients (50% vs 80%, p>0.05). Serum aspartate aminotransferase levels that were ele vated on day 4 postenrollment had returned to normal (less than or equ al to 60 U/l) by day 28 in 88% of the placebo group and in 83% of the drug-treated group. With 2 exceptions, all values were normal by 88 da ys postenrollment. We conclude that chemically defined VZV hepatitis i s an infrequent, self-limiting complication of chickenpox in otherwise healthy children and adolescents.