Mm. Jonas et al., CLINICAL AND VIROLOGICAL FEATURES OF HEPATITIS-C VIRUS-INFECTION ASSOCIATED WITH INTRAVENOUS IMMUNOGLOBULIN, Pediatrics, 98(2), 1996, pp. 211-215
Objective. To characterize the clinical features of hepatitis C virus
(HCV) infection associated with the administration of intravenous immu
noglobulin (IVIG) in patients with varied immunodeficiencies. Design.
Prospective collection of clinical and virologic data in patients dete
rmined to have HCV exposure associated with Gammagard. Setting. Outpat
ient department of Children's Hospital, Boston. Patients. Twenty-one p
atients with evidence of HCV infection were identified during a screen
ing program initiated to detect infection in exposed individuals. They
ranged from 5 to 53 years of age; 14 were children under age 18. Resu
lts. Six patients presented with severe clinical hepatitis before dete
ction by screening, 13 were detected by screening only, and 2 were fir
st detected by screening and subsequently developed symptomatic hepati
tis. Follow-up is available on 20 patients; 4 without viremia at ident
ification have remained clinically well. Hepatitis and viremia have re
solved in 2, 2 additional subjects have developed normal alanine amino
transferase (ALT) values with persistent viremia, and 13 have biochemi
cal and/or virologic evidence of chronic hepatitis. Eight patients (7
children) have undergone liver biopsies; 7 have histologic findings of
chronic hepatitis, 5 have mild fibrosis, and 2 have moderate fibrosis
. HCV genotypes 1a and Ib were observed with equal frequency in this g
roup. Conclusions. Some HCV infections associated with IVIG had a more
severe, acute course than is ordinarily described. This may be attrib
utable to host factors, such as immunodeficiencies, or virologic facto
rs, such as inoculum or genotype. Although a large percentage (87.5%)
of these individuals developed chronic infection, the natural history
is not as yet completely defined.