The Impact of Mode of Acquisition on Biological Markers of Paediatric Hepatitis C Virus Infection

K. England; C. Thorne; H. Harris; M. Ramsay; M.-L. Newell

Disclosures

J Viral Hepat. 2011;18(8):533-541. 

In This Article

Abstract and Introduction

Abstract

Despite the introduction of blood donor screening, worldwide, children continue to become infected with hepatitis C virus (HCV) via un-sterile medical injections, receipt of unscreened blood and isolated hospital contamination outbreaks. It is plausible that the natural history and disease progression in these children might differ from that of their vertically infected counterparts. Vertically and parenterally HCV-infected children were prospectively followed within the European Paediatric HCV Network and the UK National HCV Register, respectively. Biological profiles were compared. Vertically and parenterally HCV-infected children differed in terms of some key characteristics including the male to female ratio and the proportion of children receiving therapy. Parenterally infected children were more likely to have at least one hepatomegaly event during follow-up, 20%vs 10%. Parenteral infection did not significantly affect the odds of being consistently viraemic (AOR 1.14, P = 0.703) and there was no significant difference in the odds of having consistently elevated ALT levels and mode of acquisition (AOR 0.83, P = 0.748). The proportion of children with 2 or more markers of HCV infection did not differ significantly by mode of acquisition (χ2 1.13, P = 0.288). This analysis does not support substantial differences between vertically and parenterally infected groups, but there are specific mechanisms identified requiring further investigation. Given the continued parenteral infection of children worldwide, it is vital that knowledge of disease progression in this group is accurate and that the differences in comparison with vertically infected children are clarified to inform more accurate and individualized clinical management.

Introduction

Most available information about paediatric hepatitis C virus (HCV) infection is derived from a limited number of birth cohorts of vertically infected children.[1–6] Parenteral acquisition of HCV infection via contact with contaminated blood or blood products is now rare in many countries following the implementation of donor screening in the early 1990s. However, worldwide, children continue to be infected in this way as a result of unsterile medical injections, receipt of unscreened blood and via isolated hospital contamination outbreaks.[7–11]

Information on the impact of mode of acquisition of paediatric HCV infection on biological markers of infection is limited. It is plausible that given the infection of vertically infected children during early immune maturation, or the possible adaptation of the immune system of the vertically infected children following early exposure in utero, the natural history and disease progression in parenterally infected children acquiring HCV later in childhood might differ from that of their vertically infected counterparts. To inform the management of parenterally HCV-infected children worldwide, and in the light of continued outbreaks and diagnoses of new cases, it is important to understand any differences between this group and vertically infected children, upon whom the majority of paediatric HCV guidelines are based.

Using databases from two ongoing prospective cohort studies, we compared biological markers of HCV infection in children to clarify whether routinely collected biological data, which may be useful in predicting future disease outcome, differ by mode of acquisition of infection.

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