Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK.
Liver Unit, Birmingham Women's & Children's Hospital, Birmingham, UK.
J Hepatol. 2019 Mar;70(3):371-378. doi: 10.1016/j.jhep.2018.11.013. Epub 2018 Nov 27.
BACKGROUND & AIMS: Chronic hepatitis C virus (HCV) infection is a global health burden. Although HCV infection rarely contributes to morbidity during childhood, most HCV-infected children develop chronic HCV with a lifetime risk of liver disease. Little is known about the development of long-term liver disease and the effect of treatment in patients infected with HCV in childhood.
This study was a retrospective review of patients infected with HCV in childhood enrolled in HCV Research UK. A total of 1,049 patients were identified and included.
The main routes of infection were intravenous drug use (53%), blood product exposure (24%) and perinatal infection (11%). Liver disease developed in 32% of patients, a median of 33 years after infection, irrespective of the mode of infection. Therefore, patients with perinatal exposure developed cirrhosis at an earlier age than the rest of the risk groups. The incidence of hepatocellular carcinoma (HCC) was 5%, liver transplant 4% and death occurred in 3%. Overall, 663 patients were treated (55% with interferon/pegylated interferon and 40% with direct-acting antivirals). Sustained virological response (SVR) was achieved in 406 (75%). There was a higher mortality rate among patients without SVR vs. those with SVR (5% vs. 1%, p = 0.003). Treatment was more effective in patients without cirrhosis and disease progression was less frequent (13%) than in patients with cirrhosis at the time of therapy (28%) p < 0.001. Patients with cirrhosis were more likely to develop HCC, require liver transplantation, or die.
HCV infection in young people causes significant liver disease, which can now be prevented with antiviral therapy. Early treatment, especially before development of cirrhosis is essential. Detection of HCV should be aimed at relevant risk groups and antiviral therapy should be made available in childhood to prevent long-term liver disease and spread of HCV.
Chronic hepatitis C virus (HCV) infection is a global health problem, which can now be treated with potent direct-acting antiviral drugs. This study demonstrates that HCV infection in childhood causes serious liver disease in 32% of patients, a median of 33 years after infection, irrespective of age, mode and route of infection. Disease outcomes were better in patients treated before the development of advanced liver disease. Antiviral therapy should be made available in childhood to prevent long-term liver disease and the spread of HCV.
慢性丙型肝炎病毒（HCV）感染是全球健康负担。虽然 HCV 感染在儿童时期很少导致发病，但大多数 HCV 感染的儿童会发展为慢性 HCV，终生患肝病的风险较高。关于儿童期感染 HCV 的患者的长期肝病发展和治疗效果知之甚少。
本研究是对英国 HCV 研究中登记的儿童期感染 HCV 的患者进行的回顾性研究。共确定并纳入了 1049 名患者。
主要感染途径为静脉吸毒（53%）、血制品暴露（24%）和围产期感染（11%）。32%的患者发生了肝病，感染后中位数为 33 年，与感染方式无关。因此，围产期暴露的患者比其他风险组更早发展为肝硬化。肝细胞癌（HCC）的发生率为 5%，肝移植 4%，死亡 3%。总体而言，663 名患者接受了治疗（55%接受干扰素/聚乙二醇干扰素治疗，40%接受直接作用抗病毒药物治疗）。406 名患者获得持续病毒学应答（SVR）（75%）。未获得 SVR 的患者死亡率高于获得 SVR 的患者（5%比 1%，p=0.003）。无肝硬化和疾病进展的患者治疗效果更好（13%比治疗时已有肝硬化的患者更常见（28%，p<0.001）。肝硬化患者更有可能发展为 HCC、需要肝移植或死亡。
年轻人 HCV 感染会导致严重的肝病，现在可以通过抗病毒治疗来预防。早期治疗，尤其是在肝硬化发生之前，至关重要。应针对相关风险群体进行 HCV 检测，并在儿童期提供抗病毒治疗，以预防长期肝病和 HCV 的传播。
非专业人士翻译，仅供参考。
