Health-related quality of life in patients aged 6-18 years with chronic hepatitis C treated with sofosbuvir/velpatasvir

BACKGROUND & AIMS

The aim of this study was to assess the effect of treatment with sofosbuvir/velpatasvir (SOF/VEL) on the health-related quality of life (HRQL) of children with chronic hepatitis C.

METHODS

In the non-commercial, non-randomized, open-label PANDAA-PED study, 50 children aged 6-18 years with chronic hepatitis C were treated with a fixed dose of SOF/VEL. All patients achieved sustained virologic response 12 weeks after the end of treatment (SVR12). Evaluation of HRQL was performed twice: at baseline (before the treatment) and during the SVR12 analysis using the KIDSCREEN-27 questionnaires, which included 5 dimensions of HRQL, for child self-reporting and parent proxy reporting. The normal range for the population was set to T values of 50 ± 10 points. Child-parent agreement was analysed using the intra-class correlation coefficient (ICC) and Bland-Altman test.

RESULTS

Mean T values were within the normal range for all dimensions, both before and after treatment. There was a significant improvement in physical well-being based on the children's self-assessment (from 48.53 to 51.21, p = .03). In addition, a trend towards better scores in the 'social support & peers' part of the parent proxy evaluation (from 45.98 to 48.66, p = .06) was noticed. After the treatment, the proportion of children self-assessing their physical well-being as below normal significantly decreased from 17% to 5% (p = .007). HRQL scores were not associated with patients' sex, but in most cases, younger age correlated with better HRQL. Evaluation of the ICC for child self-reports versus parent proxy reports revealed poor to moderate agreement for most single measures. Bland-Altman analysis showed that in all dimensions, both before and after treatment, the limits of agreement (LoAs) exceeded ±5 points (half of the SD and considered a maximum allowed difference).

CONCLUSIONS

A significant proportion of children with chronic hepatitis C have decreased HRQL in all dimensions, but effective treatment with SOF/VEL leads to an improvement in some areas of well-being. As the effect of HCV on HRQL is more pronounced in older patients, treatment of younger children should be indicated to prevent them from experiencing decreased HRQL due to ongoing HCV infection in the future.

Efficacy and safety of treatment with sofosbuvir/velpatasvir in patients aged 6-18 years with chronic hepatitis C-Results of the PANDAA-PED study

BACKGROUND AND AIMS

The aim of this non-commercial, open-label, real-life, non-randomized clinical trial was to analyse the efficacy and safety of a pangenotypic regimen sofosbuvir/velpatasvir (SOF/VEL) in patients aged 6-18 years with chronic hepatitis C virus (HCV) infection.

METHODS

Fifty patients qualified for the 12-week treatment were divided into two weight groups: 15 children weighting between 17 and <30 kg received a fixed dose of 200/50 mg of SOF/VEL (tablet) once daily, and 35 patients weighting ≥30 kg were treated with 400/100 mg SOF/VEL. The primary endpoint of the study was efficacy defined as sustained viral response (undetectable HCV RNA using an real-time polymerase chain reaction method) at 12 weeks posttreatment (SVR12).

RESULTS

Median age of the participants was 10 (IQR 8-12) years, 47 were infected vertically, and 3 patients were previously ineffectively treated with pegylated interferon and ribavirin. Thirty-seven participants were infected with HCV genotype 1, 10 with HCV genotype 3 and the remaining 3 with genotype 4. There was no case of cirrhosis. SVR12 was 100%. Thirty-three reported adverse events (AEs) were considered related to the administration of SOF/VEL, all of them were mild or moderate. Children presenting with AEs were older compared to these without AEs: 12 (9.5-13) versus 9 (IQR 8-11) years (p = 0.008).

CONCLUSIONS

Results of the PANDAA-PED study indicated a 100% effectiveness of a 12-week therapy with SOF/VEL in children aged 6-18 years with chronic HCV infection and its good safety profile, in particular in younger patients.

Comparison of the prevalence of risk factors for Toxoplasma Gondii infection among pregnant women in rural and urban areas in Poland

Introduction

Toxoplasma gondii is a protozoan parasite. While this infection typically exhibits no symptoms in humans, it poses a potential threat to the developing fetus in pregnant women. Several risk factors contribute to toxoplasmosis infection. Adherence to hygiene protocols and avoiding the consumption of raw meat, unwashed vegetables, and fruits may mitigate the risk of this disease.

Objective

This study aimed to compare the prevalence of toxoplasmosis risk factors among pregnant women suspected of toxoplasmosis living in rural areas with those residing in urban areas.

Materials and methods

A retrospective observational study was conducted by analyzing data from the medical records of pregnant women suspected of toxoplasmosis. These women were consulted at the Provincial Infectious Diseases Hospital between September 2019 and March 2020. The analysis encompassed patients' demographic data and information concerning toxoplasmosis risk factors. A total of 273 women's data were included in the analysis. Diagnosis relied on serological verification using the VIDAS® analyzer (bioMérieux, Lyon, France).

Results

Women residing in rural areas were less likely to report a good socio-economic status (p=0.0064), and toxoplasmosis infection was less frequently ruled out (p=0.0023). In comparison to women living in urban areas, pregnant women from rural regions were more likely to have confirmed primary toxoplasmosis (p=0.0164). Additionally, they were more prone to working in gardens without gloves (p<0.0001), consuming unwashed vegetables (p=0.0025), eating raw meat during pregnancy (p=0.0008), and cats caregiving during pregnancy (p=0.0002). This exposure included both care for domestic cats before and during pregnancy (p=0.0069) and interactions with wild cats (p<0.0001).

Conclusions

Pregnant women living in rural areas exhibited significantly higher exposure to toxoplasmosis risk factors. They also displayed a higher incidence of primary infections during pregnancy and a lower rate of excluded infections.

Testing for HIV Increases the Odds of Correct Fetal Ultrasound Result

Introduction: Infectious diseases during pregnancy may pose a threat to both mother and the developing fetus. It also creates an opportunity to screen for diseases being widely underdiagnosed among women in Poland, such as human immunodeficiency virus (HIV) or sexually transmitted infections (STI). Therefore, we aimed to assess the number of pregnant women that had not been tested for HIV despite the recommendations. In addition, a comparison of clinical evaluation between HIV-tested and non-tested pregnant women was also performed. Material and methods: Medical records of all consecutive pregnant women, referred to our Infectious Diseases Hospital between September 2019 and March 2020 were retrospectively analyzed. Implementation of recommended screening testing towards infectious diseases during pregnancy including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), syphilis, and rubella, were also analyzed. Results: Medical records of 273 women were included in the analysis. The median age was 32 years (interquartile range: 26−33 years). In total 243/273 (89.0%) had been tested for HIV as recommended, and the remaining 30/273 (11.0%) had not been tested. HIV infection was not confirmed in any of the participants. Only one woman within the HIV non-tested group had been correctly tested towards other infections during her pregnancy. The recommended full testing was more likely to be correctly implemented in women who had also been tested for HIV (171/243, 70.4% vs. 1/30, 3.3%, OR 68.9; 95% CI 9.2−515.3, p < 0.00001). Moreover, the correct fetal ultrasound result was more likely to be obtained in women who had been tested for HIV as recommended (234/243, 96.3% vs. 11/30, 36.7%, OR 44.9; 95% CI 16.6−121.8, p < 0.00001). Conclusions: Despite the law regulations, 11% of pregnant women referred to consultations to the infectious diseases center had not been tested for HIV. At the same time, correct fetal ultrasound results are more likely to occur in women tested for HIV according to recommendations. This suggests that a holistic approach to screening, both for communicable and non-communicable diseases, among pregnant women may translate to better pregnancy outcomes.

Analysis of Preventable Risk Factors for Toxoplasma gondii Infection in Pregnant Women: Case-Control Study

Background: Toxoplasma gondii (TG) is a parasitic protozoon that may cause miscarriages or birth defects if the infection occurs during pregnancy. The study’s aim was to evaluate the risk factors associated with TG infection in pregnant women. Materials: Medical charts for all 273 pregnant women with suspected TG infection consecutively admitted to the Hospital of Warsaw between 2019 and 2020 were retrospectively analyzed. The presumptive TG diagnosis was verified by a serologic assessment of IgM and IgG titers, and IgG affinity tests. Results: The median age was 32 years (range: 19–42 years). The diagnosis of primary TG infection was confirmed in 74/273 (27.1%) women. In 114/273 (41.8%) there was evidence of past infection. In 71/273 (26%) women, an infection was excluded. In 172/273 (62%) women the recommended testing for other infectious diseases putting fetus development at risk was performed correctly. Logistic regression model analysis revealed that living in rural areas and eating raw meat were independent factors associated with increased risk of TG infection during pregnancy (OR 2.89, 95% CI: 1.42–5.9, p = 0.004; and OR 2.07, 95% CI: 1.03–4.18, p = 0.04, respectively). Conclusions: The independent risk factors for TG infection during pregnancy include living in rural areas and eating raw meat. The physician’s educational role here is crucial for the efficient prevention of congenital toxoplasmosis.

Liver Fibrosis Evaluated With Transient Elastography in 35 Children With Chronic Hepatitis C Virus Infection

BACKGROUND

The aim of this prospective study was to analyze liver fibrosis in teenagers with chronic hepatitis C (CHC) using noninvasive methods.

METHODS

Thirty-five patients with CHC, 12-17 years of age (mean 14.2 ± 1.8 years; 22/35, 63% male) were included. Most of them (29/35, 83%) were infected vertically, 21/35 (60%) were treatment-naive, 30/35 (86%) were infected with genotype 1 and 5/35 (14%) were infected with genotype 4 HCV. In all patients, evaluation of liver fibrosis was performed using transient elastography (TE) and measurement of the following serum biomarkers: aspartate transaminase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4). Using liver stiffness measurement (LSM) results as a reference, the diagnostic performance of APRI and FIB-4 was assessed by calculating area under the receiver operating characteristics curve.

RESULTS

Transient elastography results revealed no or mild fibrosis (F0/1 in METAVIR scale) in 31/35 (89%) patients. In 4/35 (11%) patients, significant fibrosis was observed (F ≥ 2), including 3/35 (9%) with cirrhosis (F4). The median APRI was 0.32, and the median FIB-4 was 0.32. LSM was associated with both APRI and FIB-4 [r = 0.61, 95% confidence interval (CI) 0.35-0.79, P = 0.0001; and r = 0.60, 95% CI 0.32-0.78, P = 0.0002, respectively]. For the diagnosis of significant fibrosis, the area under the receiver operating characteristics (95% CI) for both APRI and FIB-4 was 0.855 (0.695-0.951). APRI, with a cutoff >0.374, predicted significant fibrosis, with 100% sensitivity and 67.7% specificity, whereas FIB-4, with a cutoff >0.402, predicted significant fibrosis, with 75.0% sensitivity and 90.3% specificity.

CONCLUSIONS

Significant fibrosis, including cirrhosis, may occur in teenagers with CHC. Serum biomarkers (APRI, FIB-4) correlate positively with LSM.

Pegylated interferon and ribavirin gone but not forgotten in the era of direct-acting antivirals

BACKGROUND

Therapy with pegylated interferon and ribavirin (PEG-IFN+RBV) for chronic hepatitis C (CHC) remains the only option available for children in many Eurasian and European countries. Our aim was to evaluate the influence of host and viral factors on response to IFN-based therapy to optimize it for those in whom directly acting antivirals (DAA) are currently unavailable.

METHODS

Seventeen vertically infected, treatment naive children (10 male and 7 female) aged 5-16 years with CHC underwent a course of PEG-IFN+RBV. The end point was sustained virologic response (SVR). Host and virus factors were divided into pre- and on-treatment predictors of response to therapy.

RESULTS

Eleven patients obtained SVR (64%), 4 were non-responders (23%), and 2 were relapsers (12%). Significant relationship was found between HCV RNA elimination and following variables: virus genotype and early virologic response (EVR) (P<0.037, P<0.029 respectively). Higher eradication rate was observed in patients infected with genotype 3 HCV (100% vs. 65% with genotype 1 or 4), and in those with undetectable HCV RNA by week 12 (88% vs. 66% with viremia). EVR was associated with SVR (83% vs. 0% in nonresponders; P<0.004). C allele of IL28B rs12979860 was a predictor of EVR (P<0.043). The SVR rates among CC, CT, and TT carriers were as follows: 75%, 67%, and 33%.

CONCLUSIONS

Detection of favorable HCV and IL28B genotype prior to commencement of PEG-IFN+RBV and continuing it in patients with EVR is of major importance for those in whom DAA are still unavailable.

Pegylated interferon and ribavirin gone but not forgotten in the era of direct-acting antivirals

BACKGROUND

Therapy with pegylated interferon and ribavirin (PEG-IFN+RBV) for chronic hepatitis C (CHC) still remains the only option available for children in many Eurasian and European countries. Our aim was to evaluate the influence of host and viral factors on response to IFN-based therapy to optimize it for those in whom directly acting antivirals (DAA) are currently unavailable.

METHODS

Seventeen vertically infected, treatment naive children (10 male and 7 female) aged 5-16 years with CHC underwent a course of PEG-IFN+RBV. The end point was sustained virologic response (SVR). Host and virus factors were divided into pre- and ontreatment predictors of response to therapy.

RESULTS

Eleven patients obtained SVR (64%), 4 were nonresponders (23%), and 2 were relapsers (12%). Significant relationship was found between HCV RNA elimination and following variables: virus genotype and early virologic response (EVR) (p< .037, p< .029 respectively). Higher eradication rate was observed in patients infected with genotype 3 HCV (100% vs. 65% with genotype 1 or 4), and in those with undetectable HCV RNA by week 12 (88% vs. 66% with viremia). EVR was associated with SVR (83% vs. 0% in nonresponders; p< .004). C allele of IL28B rs12979860 was a predictor of EVR (p < .043). The SVR rates among CC, CT, and TT carriers were as follows: 75%, 67%, and 33%.

CONCLUSIONS

Detection of favourable HCV and IL28B genotype prior to commencement of PEG-IFN+RBV, and continuing it in patients with EVR is of major importance for those in whom DAA are still unavailable.

On a straight path to HCV elimination in children - new prospects for hepatitis C treatment in Poland

Difficulties in achieving elimination targets of the World Health Organization's Global Strategy on viral hepatitis might be overcome through a new micro-elimination approach that allows for a quick, efficient targeting of treatment and prevention services. Particular focus on identification of high-risk and so far marginalized populations, such as children and adolescents, increases chances for HCV elimination on a country, and ultimately on a population level. Therefore, a broad access to safe and highly effective direct-acting antiviral drugs is of upmost importance in the pediatric population.

Hepatitis C infection among pregnant women in central Poland: Significance of epidemiological anamnesis and impact of screening tests to detect infection

BACKGROUND

Mother-to-child transmission is one of the main sources of hepatitis C virus (HCV) infection in children. However, because of the asymptomatic course of the illness, certain women may not be aware of their infection.

OBJECTIVES

The aim of this study was to estimate the significance of epidemiological anamnesis in diagnoses of HCV infection in women of reproductive age and to evaluate how screening among pregnant women impacts the detection of HCV infection.

MATERIAL AND METHODS

Epidemiological interviews of 432 mothers infected with HCV (but free of human immunodeficiency virus (HIV)) were conducted in the Warsaw Hospital for Infectious Diseases (Poland) from 1998 to 2012.

RESULTS

Complaints or abnormalities in laboratory tests were the reasons for anti-HCV antibody testing in 28.2% of mothers, whereas specific interview responses or occupational health care services group affiliation were the reasons for testing in 35.6%. However, in a large group of women, infection was only detected because of screening examinations. The introduction of routine screening for pregnant women (since 2010 in Poland) has led to the increased detection of HCV infection in women who did not present with infection risk factors (9.9% before 2010 vs 46.1% after 2010). This practice has also led to an increase in the percentage of women diagnosed during pregnancy (21.5% before 2010 vs 30.8% after 2010).

CONCLUSIONS

Establishing HCV infection risk factors during the interview process is the most common indicator for serological testing; however, not all infected cases can be diagnosed in this manner. Screening for anti-HCV antibodies in pregnant women increases the detection of HCV infection in this group.

Liver steatosis in children with chronic hepatitis B and C: Prevalence, predictors, and impact on disease progression

Only scarce data on liver steatosis in children with chronic hepatitis B and C (CHB and CHC) are available. The objective of this study was to evaluate the prevalence, predictors, and impact of hepatic steatosis on children with CHB and CHC. A total of 78 patients aged 11.5 ± 3.4 years were included: 30 (38%) had CHB, and 48 (62%) had CHC. Steatosis was scored on a 5-point scale, as follows: absent; minimal (≤5% hepatocytes affected), mild (6-33%), moderate (34-66%), and severe (>66%). Stepwise logistic regression was used to determine the factors associated with steatosis and moderate-to-severe steatosis. Steatosis was observed in 4/30 (13%) patients with CHB and 13/48 (27%) patients with CHC (P = 0.17). Moderate-to-severe steatosis was observed in 6/78 (8%) patients: 1/30 (3%) had CHB and 5/48 (10%) had CHC (P = 0.40). The body mass index (BMI) z-score was positively associated with the presence of steatosis in children with CHB (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.02-10.64). In CHC, steatosis occurred more frequently in patients with hepatitis C virus genotype 3 compared with other genotypes (P = 0.002). In patients with non-3 genotype hepatitis C virus, steatosis was associated with the stage of fibrosis (OR = 3.35, 95% CI: 1.01-11.07) and inversely associated with the duration of infection (OR = 0.74, 95% CI: 0.55-0.97). Moderate-to-severe steatosis was positively associated with the BMI z-score (OR = 3.62, 95% CI: 1.22-10.75) and stage of fibrosis (OR = 3.89, 95% CI: 1.05-14.47). Steatosis is a common finding in children with chronic viral hepatitis. It is associated with metabolic factors in CHB, whereas in patients with CHC, metabolic and viral factors may have a combined effect, leading to more advanced grades of steatosis in children with higher BMI z-scores. Moderate-to-severe steatosis is a predictor of advanced fibrosis in children with CHC.

Predictors of Liver Disease Severity in Children with Chronic Hepatitis B

BACKGROUND

Evaluation of the liver histology is essential for the management of chronic hepatitis B (CHB) in children.

OBJECTIVES

The aim of this study was to analyze the histopathological features in children with CHB and compare them with clinical and laboratory data.

MATERIAL AND METHODS

The study comprised 30 treatment-naïve children (mean age: 12.8 ± 2.4; mean duration of infection: 11.7 ± 2.5 years; 16/30 HBeAg-positive and 14/30 HBeAg-negative), who underwent a liver biopsy due to CHB. Liver biopsies were evaluated according to the modified Knodell score.

RESULTS

A histopathological evaluation revealed mild to severe necroinflammatory activity (mean grading: 5.4 ± 3.2) and fibrosis (mean staging: 1.7 ± 0.9), irrespective of the HBeAg-status, viral load and duration of infection. One case of cirrhosis was observed. A multiple regression analysis revealed that alanine and aspartate aminotransferase (ALT and AST) levels were associated with the necroinflammatory activity (p = 0.001 for ALT, and p = 0.006 for AST). No such correlation for fibrosis was observed; however, children with elevated AST were prone to more advanced fibrosis compared to children with normal AST level (p = 0.01).

CONCLUSIONS

Children with CHB presented a wide range of liver changes over a decade after the infection. The severity of liver lesions did not differ according to the HBeAg status, viral load and duration of the infection. ALT and AST levels correlated positively with the inflammatory activity. AST seems to be a better predictor of fibrosis compared to ALT. Liver biopsy is a useful tool in evaluating the severity of liver disease in children with chronic hepatitis B, whereas clinical and laboratory parameters are weak predictors of liver injury.

Is liver biopsy still needed in children with chronic viral hepatitis?

Liver biopsy is a standard method used for obtaining liver tissue for histopathological evaluation. Since reliable serological and virological tests are currently available, liver biopsy is no longer needed for the etiological diagnosis of chronic hepatitis B and C. However, liver histology remains the gold standard as a prognostic tool, providing information about the liver disease progression (grading of necroinflammatory activity and staging of fibrosis) and serving clinicians in the management and therapeutic decisions. In general, histopathological evaluation is indicated before starting the antiviral treatment. Main limitations of the liver biopsy include its invasive and painful procedure, sampling errors and the inter- and intra-observer variability. In addition, indications for the liver biopsy in pediatric patients with chronic viral hepatitis were questioned recently, and efforts have been made toward the development of non-invasive methods as an alternative to the liver biopsy. The most commonly used methods are novel imaging studies (elastography) and combinations of biomarkers. However, to date, none of these tests was validated in children with chronic viral hepatitis. In this review, we present the current status of the liver biopsy in the management of chronic viral hepatitis B and C in pediatric population, including specific indications, complications, contraindications, problems, limitations, and alternative non-invasive methods.

The influence of hepatitis B and C virus coinfection on liver histopathology in children

The influence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on liver histology in children remains unknown. We analyzed histopathological features in 70 treatment-naïve children: 10 with HBV/HCV coinfection (case group A), 30 with HBV (control group B), and 30 with HCV (control group C). Liver biopsies were scored for grading and staging according to Knodell's modified system and were tested for an association with demographic and laboratory data. The mean grade was higher in coinfected children compared to control group C (6.2 ± 3.0 vs. 4.2 ± 2.5, p = 0.04), but not control group B (p = 0.47). A higher proportion of patients with moderate to severe necroinflammation were observed in case group A compared to isolated HCV (p = 0.05). Mean staging did not differ between the case and control groups. Multivariate analysis revealed that HBV/HCV coinfection and aminotransferase activity were independently associated with moderate to severe necroinflammatory activity Conclusion: HBV/HCV coinfection was associated with moderate to severe necroinflammation irrespective of age at biopsy or duration of infection and led to significantly higher necroinflammatory activity than HCV monoinfection. HBV/HCV coinfection did not enhance fibrosis. High aminotransferase levels were positively associated with moderate to severe necroinflammation.

[Mother-to-child HBV transmission--atypical course of hepatitis B in an infant]

The article presents the course of hepatitis B transmitted from mother to her child. In the nine-week-pregnant mother HBsAg was not detected, but five months after delivery chronic stage hepatitis B was diagnosed. The infant was vaccinated twice against HBV without HBIG. At six months of age, the infant developed acute hepatitis B and Gianotti-Crosti syndrome (GCS) with high level of aminotransferase activity. In the 2nd year of life seroconversion in the HBe system and reduction of hepatitis B activity was observed.

CONCLUSIONS

1. The double HBsAg test in pregnant women may increase the detectability of HBV infection. 2. Current prophylaxis of HBV infection is not sufficient to protect mother-to-child transmission. 3. Spontaneous regression of acute hepatitis B in infants may occur in the period of more than 6 months from the onset, that is in the chronic stage.

[Anti-HCV testing as a basic standard of monitoring HCV mother-to-child infection: advantages and disadvantages of the method]

Vertical transmission is an important route of HCV infection. Infants are considered to be infected if two or more HCV-RNA results are positive and/or anti-HCV+ over 18 mo of age. HCV-RNA RT-PCR testing requires high quality certificated centers. Anti-HCV ELISA commercial tests are cheaper and may be performed in all laboratories.

AIM

To estimate sufficiency of anti-HCV testing over 18 mo in the diagnostic process of HCV mother-to-child infection.

METHODS

317 children born to HCV infected mothers were observed for 2-4 years. HCV-RNA was determined first at the age of 2-5 mo and subsequent in 6 months intervals, anti-HCV every 3-6 months.

RESULTS

HCV infection (HCV-RNA twice presence) was recognized in 26/317 (8.2%). Anti-HCV+ were found in: 288 (91%) children in 3-6 mo of age, 213 (67.2%) in 7-9 mo, 21 (6.6%) above 18 mo. HCV-RNA was negative during all observation in the group with anti-HCV results group in all determinations in the first year of life. Among 21 children anti-HCV+ over 18 mo there were: 18 with chronic infection (HCV-RNA+, anti-HCV+), 3 achieved HCV-RNA clearance (2 became anti-HCV-, 1 anti-HCV+ during following observation). Among 296 children anti-HCV over 18 mo there were 5 children HCV-RNA+ twice in the first year of life, but all became HCV-RNA- during follow up. In 4 of them (4/296, 1.3%) in spite of anti-HCV- we transiently found HCV-RNA+ above 18 mo of age.

CONCLUSIONS

Anti-HCV presence in children born to HCV infected mothers: a) up to 18 mo of age do not confirm HCV infection. b) over 18 mo of age are indicative of HCV infection, but not always with active HCV replication. Negative results of anti-HCV above 18 mo of age usually allow us to exclude HCV replication, but in 1.3% we found HCV-RNA in anti-HCV- children. Anti-HCV testing over 18 mo of age as only diagnostic procedure may be not enough. Missing HCV replication in the first period of life prevents HCV microreplication follow up.

[Mother-to-infant HCV transmission. Can we influence the frequency and the course of the infection?]

AIM

To estimate the management of HCV infected women and their children.

METHODS

Part I/: Blood samples were collected from 544 pregnant women and tested for anti-HCV. Part II/: Data of risk factors of HCV infection, reasons of HCV diagnostics were assessed in 281 mothers infected with HCV, not infected with HIV. 317 children born to HCV infected mothers were observed from birth until age 2.5-10 years (testing of HCV-RNA, ALT). 26 (8.%) of them were infected with HCV.

RESULTS

Part I/: 22.02% of tested pregnant women were anti-HCV(+). Part II/: Presence of risk factors for HCV infection in anamnesis was the reason of HCV diagnostics in 34% of women. None of HCV-RNA(-) women transmitted HCV to their child. The rate of HCV infection in infants born to HCV-RNA(+) mothers was 14.1% and was higher in case of natural delivery (19.2%) compared to cesarean section (7.5%). Intrapartum percutaneus exposure to maternal blood increased transmission rates. All children born via elective cesarean section (in 38 Hbd) were HCV-RNA(-). None of infected children had clinical symptoms of hepatitis, however, one of them had mild changes in liver histopathology.

CONCLUSIONS

Antenatal screening of anti-HCV is not necessary, however, every woman with risk factors for HCV infection in anamnesis should be tested. Women infected with HCV ought to be treated before pregnancy in order to decrease HCV replication. The protective role of elective cesarean section requires further investigation. A number of children with chronic HCV infection should be considered for early treatment.

[Response to hepatitis B vaccine in infants with mother-to-child HCV infection]

The aim of the study was to establish the vaccination-induced anti-HBs seroconversion in a group of children with mother-to-child HCV infection.

MATERIAL AND METHODS

105 infants born to HCV infected mothers were vaccinated against hepatitis B virus (10 microg/ml; 0, 1, 6 months). HCV infection (HCV-RNA RT-PCR, Abbot Laboratories, in serum positive infants detected twice in the first year of life) was confirmed in 18 (group A). 87 infants were HCV uninfected (group B). Anti-HBs titers (Ortho-EIA) were measured 1-6 months after the third dose of immunisation.

RESULTS

Seroconversion to anti-HBs >10 mIU/ml was achieved in 93 (88.6%) infants: 13/18 (73%) in group A, 80/87 (92%) in group B. Anti-HBs <10 mIU/ml was observed in 12 (11.3%) children: 5 (27%) in group A, and 7 (8%) in group B (p=0.04).

CONCLUSION

Response to hepatitis B vaccine in infants infected with HCV was weaker than in nonvaccinated infants.

[Seroprevalence of anti-HCV in pregnant women. Risk factors of HCV infection]

Vertical transmission seems to be an important mode of infection in children. Approximately 6-9% of hepatitis C virus-positive women transmit HCV to their offsprings.

AIM

1. To determine the frequency of HCV infection in pregnant women in central Poland. 2. To estimate knowledge about HCV infection in childbearing women. 3. To identify risk factors for HCV infection among pregnant women.

METHODS

Study in two separate parts. Part A: Blood samples were collected from 544 pregnant women, tested with anti-HCV ELISA third generation tests. Part B: Data of risk factors of HCV infection, reason of diagnostics were assessed through structured interview and review of available medical records in 281 women infected with HCV.

RESULTS

Part A: 2.02% of tested pregnant women were anti-HCV(+). One of them (1/11) knew about her HCV infection before examination. Part B. 24% of 281 infected women indicate a history of blood products transfusion (all before 1992), 23%- hospitalisation with surgical procedures, 15%--intravenous drug use, 8%--hospitalisation without surgical procedures, 7%--exposures of health care personnel, 3%--infected mother, 3%--sexual partner or other member of family infected with HCV. Histories taken from 17% women did not include any known risk factors. HCV infection in women were diagnosed: before pregnancy in 186 (66%), during pregnancy in 61 (22%), after delivery in 34 (12%). All women were Caucasian, Polish nationality.

CONCLUSION

The seroprevalence of anti-HCV in pregnant women was 2.02%. There is a number of childbearing HCV infected women who are not identified as HCV positive. Selective HCV testing to women at high risk of HCV infection and antiviral therapy should be encouraged prior to conception.

[Hypocomplementaemia in children with chronic viral hepatitis as a risk factor for invasive encapsulated bacteria infection]

The complement system plays an important role in immunological and inflammatory response. Complement deficiency may increase patient's susceptibility to invasive infections caused by encapsulated bacteria (Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae). One of the causes of reduced production of complement components may be hepatic function disturbances in patients with chronic viral hepatitis.

AIM

of this study was to estimate the incidence of complement components deficiency and the risk of hypocomplementaemia as well as the associated risk of invasive bacterial infections in children with chronic viral hepatitis, type B and C.

MATERIAL AND METHODS

the studied group consisted of 58 children (45 boys and 13 girls) aged 4 to 18 years (mean 14 +/- 3 years). 35/58 were chronically infected with HBV, 17/58 with HCV while 6/58 had HBV and HCV co-infection. In every child levels of C3 and C4 complement components in serum were determined. Deficiency of C3 component was diagnosed at the level of below 90 g/dl (laboratory normal values: 90-180 g/dl): deficit of C4 component was at the level below 10 g/dl (laboratory normal range 10-40 g/dl). In 43 patients (74%), nasopharyngeal swabs were taken for encapsulated bacteria carrier state. Statistical analysis was carried out using Statistica version 7.1 programme (p<0.05).

RESULTS

hypocomplementaemia was observed in 14/58 (24%) of patients: decrease in C3 component was found in 12/58 (20.5%) of cases, decrease in C4 in 2/58 (3.5%). Among children with chronic hepatitis B 6/35 (17%) had C3 deficiency and 2/35 (6%) C4 deficiency. In 5/17 (30%) of HCV-infected children, decreased level of C3 complement component was found. In one child with HBV and HCV co-infection, a decrease in C3 level was observed. Nosopharyngeal swab was positive for Neisseria meningitidis in 2/43 (5%) of patients and for Streptococcus pneumoniae in 1/43 (2.5%).

CONCLUSIONS

1. Hepatic function disturbances in course of chronic viral hepatitis type B and C in children may lead to deficiency of complement components and further to the risk of invasive bacterial infections. 2. To assess the incidence of hypocomplementaemia and its components in children with chronic viral hepatitis, studies on a larger group of patients are needed. 3. In children with chronic viral hepatitis it is indicated to determine complement components concentration. 4. Vaccination against encapsulated bacteria infections should be recommended for patients with chronic viral hepatitis, in particular in cases with lowered complement components concentration.

[Mother-to-infant HCV transmission--rate and course of HCV infection in children]

OBJECT

to establish the rate and course of HCV infection in infants born to HCV infected mothers and to determine abilities of prevention.

METHODS

155 children born to HCV infected mothers were observed from birth until age 18-48 months. Serum of infants was tested for HCV-RNA (RT-PCR, Amplicor v 2.0 Roche), for anti-HCV (EIA v. 2) and ALT activity. Infants were classified as HCV infected if their serum was found to be positive for HCV-RNA at least twice during first year of life. In 11 mothers and their newborns serum and PBMC from venous blood and from the umbilical cord were collected during delivery and examined-using nested RT-PCR.

RESULTS

The overall HCV vertical infection rate was 11%. Transmission occurred more frequently in children with intrapartum exposure to maternal blood by percutaneus inoculation. None of the infected infants had clinical symptoms of hepatitis. ALT abnormal activity was detected in 43% of infected children. HCV-RNA was detected in mothers' serum and PBMC collected during delivery in 9 (9/11) samples. HCV-RNA was detected in samples from umbilical cord in serum in 7 (7/11) and in PBMC in 4 (4/11) cases.

CONCLUSIONS

The risk of HCV vertical infection in present study was high. Intrapartum percutaneus exposure to maternal blood increased transmission rates. Further investigation to determine the effectiveness of antiviral therapy in prevention of mother-to-infant HCV transmission should be performed. The role of PBMC in mother-to-child HCV transmission should be investigated.

[Lamivudine treatment of chronic hepatitis B in children after treatment with interferon alfa--evaluation of the effectiveness of prolonged therapy]

AIM

To investigate the efficacy of lamivudine therapy in children with chronic hepatitis B who did not respond to interferon therapy in the past.

MATERIAL AND METHODS

Thirty four children aged 7-16 were given lamivudine for 12 months. Because of replication of HBV, 21 children were treated for the next 12 months (up to 24 months). Lamivudine was given in the dose 3-5 mg/kg per day (maximum 100 mg). Normalisation of aminotransferase, seroconversion HBe/anti-HBe and HBV DNA clearance were recognized as effective or promising prognosis of treatment.

RESULTS

The response rate was 24% (8/34) and 29% (6/21) after 12 and 24 months respectively. In the first year of therapy the most significant was normalisation of aminotransferase, in the second year, seroconversion HBe/anti-HBe.

CONCLUSIONS

1. Lamivudine was effective in treatment of children with chronic hepatitis B, who did not respond to interferon alfa in the past. 2. Effectiveness of Lamivudine in longer period of treatment was increased from 24% at 12 months to 29% at 24 months. 3. Treatment of more than 12 months in children with replication hepatitis B virus, but initially normal aminotransferase, could cause Lamivudine resistance.

[Hepatitis C--epidemiology, diagnosis and treatment in children]

OBJECTIVE

Epidemiology dates of hepatitis C in children are not well known because of usually asymptomatic course of disease. Vertical transmission has became one of the most common route of hepatitis C virus infection in children.

METHODS AND MAIN OBSERVATIONS

Twenty one infants of twenty HCV positive mothers were studied from 1998 to 2000 in the Clinic of Infectious Disease in Childhood of Medical University in Warsaw. Five of the infants were HCV RNA positive. All uninfected children became HCV-antybody negative by 12 months.

RESULTS AND CONCLUSIONS

Chronic infection is common in most cases of HCV infection, but the disease progression is slower than in adults. Experience of treatment of chronic hepatitis C in children is limited, with about 40% having sustained response to the interferon therapy. Combinated therapy with interferon and ribavirin may give a better response.