Original Article

European Journal of Pediatrics

, Volume 173, Issue 8, pp 1025-1031

Natural history of vertically acquired HCV infection and associated autoimmune phenomena

  • Silvia GarazzinoAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s HospitalDepartment of Pediatrics, Infectious Diseases Unit, Regina Margherita Children’s Hospital Email author 
  • , Carmelina CalitriAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
  • , Antonella VersaceAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
  • , Alda AlfaranoAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
  • , Carlo ScolfaroAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
  • , Chiara BertainaAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s HospitalUnit of Immunology and Infectious Diseases, University-Hospital Pediatric Department, Bambino Gesù Children Hospital, IRCCS
  • , Simona VatranoAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
  • , Federica MignoneAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
  • , Francesco LicciardiAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
    • , Clara GabianoAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital
    • , Pier-Angelo TovoAffiliated withDepartment of Pediatrics, University of Turin, Regina Margherita Children’s Hospital

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.

Keywords

Hepatitis C Mother-to-child transmission Non-organ-specific autoantibodies Cryoglobulinemia