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. 2024 Sep 1;43(9):813-818.
doi: 10.1097/INF.0000000000004374. Epub 2024 May 23.

Natural History and Management of Hepatitis C in Children: 25 Years Experience of a Reference Center in Northern Italy

Affiliations

Natural History and Management of Hepatitis C in Children: 25 Years Experience of a Reference Center in Northern Italy

Francesca Musto et al. Pediatr Infect Dis J. .

Abstract

Hepatitis C virus (HCV) infection natural history and management in the pediatric population are still debated. We retrospectively evaluated the outcome of a HCV pediatric population managed at the Pediatric Infectious Disease Unit of Luigi Sacco Hospital (Milan, Italy) from January 1997 to January 2022 (median follow-up 10 years) and we focused on the role of new drugs and transient elastography. Fifty-seven patients were enrolled: 8 (14%) had a spontaneous clearance, 33 were treated (58%), 7 (12%) were not treated because they were under 12 years old and 9 were lost at follow-up. HCV RNA was undetectable in all treated patients at the end of therapy, after 12 weeks (SVR12) and for the rest of their follow-up. All patients treated underwent elastography before and 1 year after therapy. Median stiffness pretherapy was 5.6 kPa, and 9 patients (16%) had abnormal transient elastography (>7 kPa, median 8.7 kPa). Median stiffness after treatment in the abnormal group was 6.8 kPa. Direct-acting antiviral agents are a safe and effective therapy for HCV chronic infection in the pediatric population. Liver elastography is normal in many vertically infected children before 12 years, but, when abnormal, it shows a significant improvement after direct-acting antiviral agent treatment. Further studies are needed to evaluate the role of elastography at diagnosis and follow-up in children.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
HCV pediatric population study cohort.
FIGURE 2.
FIGURE 2.
Significant modifications after antiviral therapy exams: AST (A), ALT (B) and HCV RNA viral load (C). D: Nonparametric Wilcoxon signed-rank test compare fibroscan value pre- and post-therapy. ****extremely significant P < 0.0001; ** very significant P < 0.01–0.001; * significant 0.05–0.01. E: Linear regression between stiffness pre-TP and AST pre-TP (P = 0.003, Pearson correlation coefficient r = 0.5662).

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