Liver Fibrosis Evaluated With Transient Elastography in 35 Children With Chronic Hepatitis C Virus Infection

Abstract

Background: The aim of this prospective study was to analyze liver fibrosis in teenagers with chronic hepatitis C (CHC) using noninvasive methods. Methods: Thirty-five patients with CHC, 12–17 years of age (mean 14.2 ± 1.8 years; 22/35, 63% male) were included. Most of them (29/35, 83%) were infected vertically, 21/35 (60%) were treatment-naive, 30/35 (86%) were infected with genotype 1 and 5/35 (14%) were infected with genotype 4 HCV. In all patients, evaluation of liver fibrosis was performed using transient elastography (TE) and measurement of the following serum biomarkers: aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4). Using liver stiffness measurement (LSM) results as a reference, the diagnostic performance of APRI and FIB-4 was assessed by calculating area under the receiver operating characteristics curve. Results: Transient elastography results revealed no or mild fibrosis (F0/1 in METAVIR scale) in 31/35 (89%) patients. In 4/35 (11%) patients, significant fibrosis was observed (F ≥ 2), including 3/35 (9%) with cirrhosis (F4). The median APRI was 0.32, and the median FIB-4 was 0.32. LSM was associated with both APRI and FIB-4 [r = 0.61, 95% confidence interval (CI) 0.35–0.79, P = 0.0001; and r = 0.60, 95% CI 0.32–0.78, P = 0.0002, respectively]. For the diagnosis of significant fibrosis, the area under the receiver operating characteristics (95% CI) for both APRI and FIB-4 was 0.855 (0.695–0.951). APRI, with a cutoff >0.374, predicted significant fibrosis, with 100% sensitivity and 67.7% specificity, whereas FIB-4, with a cutoff >0.402, predicted significant fibrosis, with 75.0% sensitivity and 90.3% specificity. Conclusions: Significant fibrosis, including cirrhosis, may occur in teenagers with CHC. Serum biomarkers (APRI, FIB-4) correlate positively with LSM.

One-Year Outcomes after Ledipasvir/Sofosbuvir Treatment of Chronic Hepatitis C in Teenagers with and without Significant Liver Fibrosis—A Case Series Report

“…The risk of cirrhosis in HCV-infected children and adolescents was estimated at 1 to 2% [ 1 , 2 , 3 , 4 , 5 ]. However, a number of recent observational studies have demonstrated that a higher proportion of pediatric patients than had been previously thought may develop advanced liver disease resulting from HCV infection [ 6 , 7 , 8 ]. Turkova et al demonstrated bridging fibrosis in 41% of their patients by histopathological evaluation with a median age of 10.4 years, and liver stiffness measurement (LSM) over 5.0 kPa in transient elastography (TE) evaluation in 30% of patients [ 7 ].…”

“…However, only a few outcomes of DAA treatment in cirrhotic pediatric patients have been reported, and there is scarce and limited data on the influence of these therapies on liver fibrosis [ 9 , 10 ]. We recently reported that among our 35 patients aged 12–17 years qualifying for ledipasvir/sofosbuvir (LDV/SOF) treatment, 11% of cases presented with significant fibrosis (F ≥ 2 on the METAVIR scale), including 9% with cirrhosis [ 6 ]. Thus, in this paper, we aim to present the one-year outcomes after therapy in this specific group of patients.…”

The micro-elimination approach - a new way of tackling hepatitis C in paediatric population

“…Although, histopathological changes in liver tissue are characterized by low inflammatory activity and low stages of fibrosis (unlike in adults), they progress over the time. In case of 2-5% of infected children, they may lead to serious liver damage, including cirrhosis (1.8%) and hepatocellular carcinoma (HCC; rarely encountered, a few case reports) [13,14,19,27,39,42].…”

Long-term Outcomes of Ledipasvir/sofosbuvir Treatment of Chronic Hepatitis C in Four Teenagers With Significant Liver Fibrosis

“…The risk of cirrhosis in HCV-infected children and adolescents was estimated at 1 to 2% [1][2][3][4][5] . However, a number of recent observational studies have demonstrated that a higher proportion of pediatric patients than had been previously thought may develop advanced liver disease resulting from HCV infection [6][7][8] . Turkova et al demonstrated bridging brosis in 41% of their patients by histopathological evaluation with a median age of 10.4 years, and liver stiffness measurement (LSM) over 5.0 kPa in transient elastography (TE) evaluation in 30% of patients 7 .…”

“…However, only a few outcomes of DAA treatment in cirrhotic pediatric patients have been reported, and there is scarce and limited data on the in uence of these therapies on liver brosis 9,10 . We recently reported that among our 35 patients aged 12-17 years qualifying for ledipasvir/sofosbuvir (LDV/SOF) treatment, 11% of cases presented Loading [MathJax]/jax/output/CommonHTML/fonts/TeX/fontdata.js with signi cant brosis (F ≥ 2 in METAVIR scale), including 9% with cirrhosis 6 . Thus, in this paper, we aim to present the long-term outcomes of therapy in this speci c group of patients.…”