An updated follow‐up of chronic hepatitis C after three decades of observation in pediatric patients cured of malignancy

Abstract

BackgroundThe aim of the study was to evaluate the clinical characteristics and the long‐term outcome of chronic hepatitis C in a cohort of Caucasian children cured of pediatric malignancy.ProcedureThe study population included 83 consecutive patients, referred to our Center with a diagnosis of leukemia/lymphoma (50) or solid tumors (33) between 1977 and 1989 and infected with hepatitis C virus (HCV) during chemotherapy.ResultsAt enrollment 77 subjects were HCV‐RNA positive. After a median follow‐up of 21 years (range 13–36), a sustained virological response (SVR) was obtained in 3 of 29 patients (10%) treated with interferon (IFN), in 1 of 3 patients (33%) treated with IFN and ribavirin, and in 5 of 11 patients (42%) treated with pegylated‐IFN and ribavirin (P = 0.03). Forty‐two patients remained untreated and only one (2.5%) cleared viremia. Four of 77 patients (5%) developed cirrhosis while other 4 patients died of causes not related to liver. At last follow‐up, 72% of HCV‐RNA positive patients had abnormal ALT.ConclusionsIn patients cured of pediatric malignancy chronic hepatitis C tends to run an indolent course during childhood and adolescence but more than 70% of treated and more than 80% of untreated cases children maintained HCV viremia. Moreover, after 2–3 decades of observation, 60% of HCV‐RNA positive patients had abnormal ALT and 5% had developed cirrhosis. Among treated patients, IFN or pegylated‐IFN and ribavirin obtained the higher rate of HCV‐RNA clearance. Pediatr Blood Cancer 2010;55:108–112. © 2010 Wiley‐Liss, Inc.

Management of chronic hepatitis C infection in children

“…Similar course and progression of HCV were seen in pediatric patients with a history of malignancies, with about 20% of patients demonstrating spontaneous clearance and up to 5% of patients showing progression to cirrhosis [17,18].…”

Hepatitis C virus infection in children and adolescents

“…Comorbidities, including hemolytic anemia, malignancy, immunosuppression, HIV, and hepatitis B virus (HBV) co‐infection and certain genetic factors, like single‐nucleotide polymorphisms, may also promote progression 83. Similarly, children with comorbid conditions, such as obesity, HIV, and HBV co‐infections, cancer, and anemia, are at risk for more severe disease 4, 84. In addition, high‐risk behaviors are associated with poor outcomes of disease, including alcohol use, IVDA, homelessness, and incarceration 70, 85, 86, 87, 88…”

High Response Rate to Pegylated Interferon Alpha and Ribavirin Combination Therapy in Hemophilic Children with Chronic Hepatitis C; A Case-Control Study

“…The most prevalent HCV genotypes among Iranian hemophilic patients were HCV genotype-1a and -3a with 58% and 18.5% of prevalence, respectively [5]. Antiviral therapy would help to prevent the long-term sequel of chronic infection, improve the prognosis of disease, and reduce healthcare expenditure [6,7]. The burden of hepatitis C in Iranian patients with inherited coagulation disorders decreased significantly following use of treated clotting factors and screening and treatment of HCV in these patients.…”