Rapid virological response in hepatitis C virus genotype 1 and early ribavirin exposure

✍ Scribed by Chia-Yen Dai; Wan-Long Chuang; Jee-Fu Huang; Ming-Yen Hsieh; Ming-Lung Yu

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 57 KB
• Volume: 48
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.22409

✦ Synopsis

We thank Iorio et al. for their interest in our work and for making us aware of their study, 1 which included some information on liver biopsies in 64 children. Their findings support those of our and other series, namely that chronic hepatitis C in children is generally histologically mild but may occasionally result in advanced fibrosis and cirrhosis. By design, our own study excluded children with decompensated cirrhosis, so if anything, our collection of liver biopsies could have been biased toward more mild disease. None of the patients in the study by Iorio et al. initially had cirrhosis, but it is noteworthy that three children (5.2%) in that series, ages 2.1, 2.7, and 13.6 years, already had Ishak stage 4 fibrosis, which is defined as marked bridging fibrosis. 2 Furthermore, one child in that series, who was initially stage 2, progressed to stage 5 (incomplete cirrhosis) on subsequent biopsy after failing antiviral therapy. Although not observed in the reported large series, there are even reports of hepatocellular carcinoma following hepatitis C acquired in childhood. 3,4 All observers agree that a minority of patients with hepatitis C will progress to cirrhosis and its complications, and although there are known risk factors for progression, it is impossible to know for certain which patients will progress. The fact that some children already have advanced fibrosis, even with a short duration of disease and with no obvious clinical differences from the rest, can only lead to the conclusion that an unknown proportion of others will eventually have the same outcome if there is not an effective therapeutic intervention.