Histopathology of hepatitis C in children, a systematic review: implications for treatment

Abstract

Chronic hepatitis C in children is usually considered a clinically mild and slowly progressive disease. Few pediatric studies focused on histopathology of children with hepatitis C are available. Those available show, overall, a wide spectrum of findings ranging from normal liver to cirrhosis and hepatocellular carcinoma. The present systematic review provides a comprehensive overview of the studies that explored histopathology in children with hepatitis C. Factors affecting the presence and the degree of necroinflammation, fibrosis and steatosis and the risk of progression to advanced liver disease were extensively evaluated. Insights on the possible role of histopathology findings in the decision-making process of whether or not to treat children with hepatitis C are provided.

Keywords:

• advanced liver disease
• children
• cirrhosis
• co-infection
• hepatitis C virus
• histopathology
• liver biopsy
• treatment

Financial & competing interests disclosure

G Indolfi has received a grant from the Ente Cassa di Risparmio di Firenze. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. The authors report no conflict of interest. The paper was partially supported by a grant received from the Ente Cassa di Risparmio di Firenze.

Key issues

• Hepatitis C is the leading cause of chronic infectious hepatitis in children in industrialized countries.

• Chronic hepatitis C is described in 80% of the children vertically infected.

• Few studies focused on histopathology in children with hepatitis C are available.

• In general, in comparison with adults, children more often exhibit a mild disease activity and a low degree of fibrosis.

• Minimal/mild necroinflammatory changes have been described in the vast majority of children with chronic hepatitis C.

• In most pediatric studies, portal-periportal fibrosis was the prevalent pattern of fibrosis.

• Advanced liver disease, defined by the presence of bridging fibrosis or cirrhosis, may be observed.

• Despite some discordant results, most studies showed that the extent of fibrosis correlated closely with the severity of histological necroinflammation, age of the child and duration of infection.

• Children coinfected with HIV or HBV present more severe liver disease when compared with monoinfected children.

Notes