SEROLOGIC, VIROLOGICAL, AND HISTOLOGIC CHARACTERISTICS OF CHRONIC PHASE HEPATITIS-C VIRUS-DISEASE IN CHILDREN INFECTED BY TRANSFUSION

Objective. We studied the time course of hepatic dysfunction, seroposi tivity to hepatitis C virus (HCV) antibodies, viremia, and histologic evidence of hepatic injury to evaluate the course of HCV infection in children infected by blood transfusion. Patients and methods. Twenty-n ine patients (ages 4 to 18 years) who underwent open-heart surgeries f or congenital heart disease were grouped into three categories based o n alterations in serum alanine aminotransferase (ALT) levels: Group A, acute infection; Group B, subacute infection; and Group C, chronic in fection. Results. In Group C, all 13 patients had detectable HCV RNA i n serum. In contrast, all patients in Group A had no detectable HCV RN A. In Group B, one of nine patients had detectable HCV RNA and two of four patients examined had persistent chronic hepatitis by histologic criteria. Antibodies directed against C100-3 antigen or core-antigen w ere more useful than second-generation HCV antibody assays in determin ing the relationship between viremia and immunologic response. Infecti on with HCV genotype II and the presence of higher HCV RNA copy number s were associated with histologic evidence of hepatic damage. Conclusi on. An abnormal ALT value is frequently associated with viremia, and b iochemically resolved acute infection reflects clearance of HCV. Howev er, a normal ALT does not always reflect an absence of hepatocyte dama ge and HCV replication in patients with subacute disease. The measures outlined in this study are useful indicators of disease activity duri ng the chronic phase of post-transfusion HCV infection.