Children with chronic hepatitis cannot be treated simply like miniature
adults. Specific issues and questions need to be addressed when dealing
with the pediatric age group.
Pediatric patients are less likely than adults to have symptoms of infection
with hepatitis C, leaving the viruses undetected and possibly unknowingly
spread. According to information available on the natural history of HCV,
the percentage of children who become chronic and the long-term outcomes
are similar to the percentage of adults. Children who are chronic
carriers of HCV have normal growth patterns.
Liver biopsy appears to be less valuable in children than adults.
Chronic hepatitis rarely progresses to cirrhosis in children.
In 16 HCV children followed for up to 14 years, encephalopathy (mental
confusion), ascites (swollen stomach), or bleeding did not develop. The
lack of cirrhosis in children with HCV is consistent that a time period
of 10 to 20 years or more is required for cirrhosis to
occur. Hepatocellular carcinoma occurs very rarely in the pediatric
group.
Few studies exist examining interferon use in children with chronic HCV,
however a recent study in Hepatology suggests that interferon therapy may
be beneficial The rates of initial and long-lasting response were higher
in the study than those observed in adults treated with standard
schedules. Possible explanations include the shorter time of infection in
children, and that most have a mild form of liver disease. The results of
this study are encouraging, according to the researchers, but more
investigation needs to be conducted.
Many questions still remain about chronic hepatitis C in children.
Further studies need to be done to determine the disease’s course and progress as well as the role of interferon treatment. (Leslie Gibbenhuck, President, Children’s Liver Alliance, Canada bchepc@telus.net)
