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Natural history of vertically acquired HCV infection and associated autoimmune phenomena

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Abstract

The natural history of vertically acquired HCV infection is ill defined. The aim of this study was to outline the natural course of vertical HCV infection in a cohort of untreated children, including rate of spontaneous viral clearance, frequency and features of HCV-related autoimmune disorders. Children with vertical HCV infection were prospectively followed from the first month of life with regular clinical and laboratory assessments. Statistical analysis was performed using Prism 5.0. Forty-five children (median age 12 years, interquartile range 6.9–15.5) were studied. Genotype 1 was predominant (53.3 %). Spontaneous viral clearance was achieved by 12 patients (26.7 %) and associated with genotype 3. Alanine-amino-transferase levels were increased in most children in the first 2 years of life with higher values in those who later cleared the infection. All children were asymptomatic for liver disease. Transient elastography (32 patients) showed mild or moderate fibrosis in nine and two cases, respectively. Non-organ-specific autoantibodies were detected in 24 children (53.3 %) independently of viremia; of these, one developed type-1 diabetes. Cryoglobulinemia was associated with genotype 1 infection and found in 15 subjects (33.3 %): two had low C4 levels and persistent proteinuria. Conclusions: Vertically acquired HCV infection may result in spontaneous clearance in up to 27 % of children. Resolution of infection is higher with genotype 3, usually occurs in preschool age and persists over time. Chronic infection is generally asymptomatic, although hepatomegaly and mild fibrosis may develop. Autoantibodies and cryoglobulins are frequent, whereas the associated clinical manifestations are rare.

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Abbreviations

ALT:

Alanine-amino-transferase

AMA:

Antimitochondrial antibodies

ANA:

Antinuclear antibodies

CI:

Confidence interval

ELISA:

Enzyme-linked immunosorbent assay

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

IFN:

Interferon

L:

Litre

LKM-1:

Liver kidney microsomal type 1 antibodies

NA:

Not available

ND:

Not detected

NOSAs:

Non-organ-specific autoantibodies

PCR:

Polymerase chain reaction

RNA:

Ribonucleic acid

SMA:

Antismooth muscle antibodies

SVC:

Sustained viral clearance

U:

Unit

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Conflict of interest

The authors have no conflicts of interest to declare and no financial supports to disclose.

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Authors and Affiliations

  1. Department of Pediatrics, University of Turin, Regina Margherita Children’s Hospital, Turin, Italy

    Silvia Garazzino, Carmelina Calitri, Antonella Versace, Alda Alfarano, Carlo Scolfaro, Chiara Bertaina, Simona Vatrano, Federica Mignone, Francesco Licciardi, Clara Gabiano & Pier-Angelo Tovo

  2. Unit of Immunology and Infectious Diseases, University-Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy

    Chiara Bertaina

  3. Department of Pediatrics, Infectious Diseases Unit, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126, Turin, Italy

    Silvia Garazzino

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  1. Silvia Garazzino
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  2. Carmelina Calitri
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  3. Antonella Versace
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  11. Pier-Angelo Tovo
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Correspondence to Silvia Garazzino.

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Communicated by David Nadal

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Garazzino, S., Calitri, C., Versace, A. et al. Natural history of vertically acquired HCV infection and associated autoimmune phenomena. Eur J Pediatr 173, 1025–1031 (2014). https://doi.org/10.1007/s00431-014-2286-6

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  • DOI: https://doi.org/10.1007/s00431-014-2286-6

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