Evaluating Progression of Liver Disease From Repeat Liver Biopsies in Children With Chronic Hepatitis C: A Retrospective Study

Children's National Medical Center, The George Washington School of Medicine, Washington DC. .
Hepatology (Impact Factor: 11.19). 11/2013; 58(5). DOI: 10.1002/hep.26519
Source: PubMed

ABSTRACT Clinical and histologic progression of liver disease in untreated children with chronic hepatitis C virus (HCV) infection is poorly documented. The aim of this retrospective study was to characterize changes in liver histology over time in a cohort of HCV- infected children who had more than one liver biopsy separated by over one year. 44 untreated children without concurrent liver diseases, who had repeat liver biopsies at eight US based medical centers, were included. Biopsies were scored by a single pathologist for inflammation, fibrosis and steatosis and were correlated with demographic data including age at biopsy, time from infection to biopsies, and laboratory values such as serum alanine aminotransferase (ALT). Mode of transmission was vertical in 25 (57%) and from transfusions in 17 children (39%). Genotype 1 was present in 30/35 (84%) children. Mean age at first and final biopsy was 8.6 and 14.5 years respectively and the mean interval between biopsies,5.8 ± 3.5 years. Duration of infection to biopsy was 7.7 and 13.5 years respectively.Laboratory values did not change significantly between the biopsies. Inflammation was minimal in about 50 %at both time points.Fibrosis was absent in 16% in both biopsies, limited to portal/periportal in73% in the first biopsy and 64% in the final biopsy. Between the two biopsies, the proportion of patients with bridging fibrosis/cirrhosis increased from 11 to 20% (p =0.005).Conclusion: Although in aggregate this cohort did not show significant histologic progression of liver disease over five years, 29.5% (n= 13)of children showed an increase in severity of fibrosis.These findings may have long term implications for the timing of follow-up biopsies and treatment decisions. (HEPATOLOGY 2013.).

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    ABSTRACT: The influence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on liver histology in children remains unknown. We analyzed histopathological features in 70 treatment-naïve children: 10 with HBV/HCV coinfection (case group A), 30 with HBV (control group B), and 30 with HCV (control group C). Liver biopsies were scored for grading and staging according to Knodell’s modified system and were tested for an association with demographic and laboratory data. The mean grade was higher in coinfected children compared to control group C (6.2 ± 3.0 vs. 4.2 ± 2.5, p = 0.04), but not control group B (p = 0.47). A higher proportion of patients with moderate to severe necroinflammation were observed in case group A compared to isolated HCV (p = 0.05). Mean staging did not differ between the case and control groups. Multivariate analysis revealed that HBV/HCV coinfection and aminotransferase activity were independently associated with moderate to severe necroinflammatory activity Conclusion: HBV/HCV coinfection was associated with moderate to severe necroinflammation irrespective of age at biopsy or duration of infection and led to significantly higher necroinflammatory activity than HCV monoinfection. HBV/HCV coinfection did not enhance fibrosis. High aminotransferase levels were positively associated with moderate to severe necroinflammation.
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