Epidemiologic features of 348 children with hepatitis C virus infection over a 30-year period: a nationwide survey in Japan

Abstract

This largest nationwide cohort study of Asian children with HCV infection spanned the last three decades. None of these Japanese children developed cirrhosis or hepatocellular carcinoma. Maternal transmission increased to account for 99% of cases during the last decade. Genotype 2 now is most prevalent in these children. Histopathologically, most children with chronic hepatitis C showed mild fibrosis or none.

Hepatitis C virus infection in children and adolescents

“…In contrast to the several landmark large and long-term cohort studies in adults, there have been only two moderate sized (>100 children) prospective studies with longer-term follow-up (>4 years): one study of 504 Italian children and adolescents followed for a mean of 5•9 ± 3•8 years after recruitment, and 10•6 ± 6•0 years from putative time of infection; 5 and the European Paediatric HCV Network (EPHN) multicentre prospective study of 266 children born to HCVinfected women followed for a median of 4•2 years (range 3•2 months -15•9 years). 6 There are also three large retro/prospective studies with long-term follow-up:-a cohort of 113 HCV-seropositive paediatric cancer patients from the United States followed for a median of 30 years (IQR 28-36) postcancer diagnosis 30 ; a national cohort of 348 children from Japan followed for 30 years, 7 and a recently published UK cohort of 1049 persons infected with HCV in childhood, of which 53% were infected through injecting drug use in adolescence, and 24% through receipt of contaminated blood products. 31 There are also several other smaller prospective 32,33 and retrospective cohorts and case studies.…”

“…Much less attention has been paid to testing, treatment and preventive strategies among children and adolescents, in part because until recently none of the DAA regimens had been approved for use in persons less than 18 years, and there were major gaps in evidence to inform paediatric specific management practices and policies. For example, there has been only one recent systematic review of seroprevalence of paediatric HCV infection; 4 only three moderate sized prospective studies with long-term follow-up [5][6][7] have examined the long term natural history and the risk of complications in children with perinatal HCV acquisition, and to date only three registration trials have been completed on the safety and efficacy of DAA regimens for treatment of HCV infection in adolescents (aged 12 years or more). [8][9][10] While more than eight different DAA combinations are available for treatment in adults, only two DAA regimens (sofosbuvir plus ribavirin and sofosbuvir/ledipasvir) have been approved for HCV treatment in adolescents.…”

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…(232)(233)(234)(235)(236) HCV-related liver disease generally progresses more slowly in children and adolescents compared to adults, although disease progression is unpredictable. (191,221,(237)(238)(239) Despite a paucity of data evaluating risk factors for HCV disease progression in the pediatric population, children with comorbid conditions (e.g., obesity with nonalcoholic fatty liver disease, congenital heart disease with elevated right heart pressures, and HIV and/or HBV coinfection) and those receiving hepatotoxic drugs require careful monitoring. (87)(88)(89)(90)191,226,240) Advanced HCV-related liver disease develops infrequently in children and teens, usually occurring more than 30 years after initial infection.…”

Ledipasvir‐sofosbuvir for treating Japanese patients with chronic hepatitis C virus genotype 2 infection

“…Genotype 2 HCV accounts for approximately 25%‐30% of chronic HCV infections in Japan, and there is evidence this percentage is higher among persons younger than 40 years and those who inject drugs . Maternal transmission of HCV has increased significantly in Japan in the last decade, and HCV genotype 2 is now the most prevalent HCV genotype in Japanese children less than 17 years old …”