Hepatitis C infection in children: A Melbourne perspective

Objective: To examine the clinical spectrum of hepatitis C virus (HCV) infe cted children in our care by determining presentation, mode of acquisition, degree of co-infection, biochemical evidence of persisting hepatitis and t reatment outcome. Methodology: A retrospective review of the medical records of all children attending the Royal Children's Hospital, Melbourne, between 1990 and 1998, who had antibodies to HCV infection detected. Detailed clinical information , investigations and the results of treatment were extracted from the clini cal notes. Results: A total of 94 children (age range 2 weeks to 19.7 years) were iden tified, of whom nine had passive transfer of maternal antibodies from HCV-p ositive mothers and were excluded from analysis. Sixty-seven children (79%) were infected by transfusion of blood or blood products. Perinatal transmi ssion occurred in 11 children (13%), and six children (7%) had a history of i.v. drug abuse. The majority of children were asymptomatic at presentatio n. Of the 65 patients tested for HCV-ribonucleic acid, 43 (66%) were positi ve. Fifty-seven cases had serial alanine aminotransaminase (ALT) measuremen ts over a mean of 28 months. Of these, 38 (67%) had an abnormal ALT. Ten ca ses (12%) were co-infected with hepatitis B virus, HIV or both. Of 12 patie nts treated with interferon, four responded with normalisation of ALT from 3 to 12 months post-commencement of therapy. Conclusions: Although HCV was largely an asymptomatic condition in our clin ic population, more than half the patients had biochemical evidence of ongo ing liver damage. Given the chronicity of this infection in the majority of patients and the long-term risks of cirrhosis and hepatocellular carcinoma , children with HCV infection represent a high-risk group worthy of regular follow up.