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

Materials and Methods

Children with vertically acquired HCV infection were identified from the European Paediatric HCV Network (EPHN) and those with parenterally acquired HCV infection were identified from the Health Protection Agency's UK National HCV Register.[2,12] Vertically infected children were prospectively followed from birth according to a study protocol described elsewhere with routine follow-up visits at least every 6 months.[2] Data on parenterally infected children were collected every 2 years from UK clinicians and follow-up began after notification of the child via one of several surveillance/lookback initiatives which often occurred some years after acquisition of infection. Full details of the study protocol are listed elsewhere.[12]

For the purposes of the present study, vertically infected children were those with a positive HCV antibody result at or after 18 months of age and/or two consecutive positive HCV RNA PCR test results at any age who were born to mothers with HCV infection confirmed before or during pregnancy. Parenterally infected children were those who tested positive to HCV antibodies with a known parenteral risk factor for infection and follow-up information available before 18 years of age. HIV/HCV-coinfected children were not included. Clearance of viraemia was defined as two consecutive negative HCV RNA PCR test results following confirmed infection. A sustained virological response (SVR) to treatment was defined by consecutive negative HCV RNA PCR tests 6 months after the cessation of treatment.[13]

The estimated date of HCV infection in the parenterally infected study population was the date of transfusion or receipt of blood products. Fifty (40%) children were transfused outside the United Kingdom or received multiple transfusions during childhood, and thus the date of infection could not be accurately estimated. Elevated ALT levels were defined as >60 IU/L in boys and 50 IU/L in girls younger than 18 months of age and 40 IU/L in boys and 35 IU/L in girls older than 18 months.[14]

Statistical Analyses

ALT SD z-scores were calculated for HCV-infected children using LMS software (LMS 1.22; Institute of Child Health, London) and maximum penalized likelihood methods,[15] giving a measure of how far from the reference group each ALT level was, accounting from age at measurement. Comparisons between parenterally and vertically infected children were carried out using Chi-squared tests or Mann–Whitney ranksum tests.[16] Logistic regression identified factors associated with ALT, PCR and hepatomegaly summary variables. Statistical analyses were performed using Stata software, version 9 (Stata Corporation, College Station, TX, USA).

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