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. 2019 Jul;26(7):881-892.
doi: 10.1111/jvh.13093. Epub 2019 Apr 7.

Advanced liver disease in Russian children and adolescents with chronic hepatitis C

Anna Turkova  1   2 , Galina V Volynets  3   4 , Siobhan Crichton  1 , Tamara A Skvortsova  4   5 , Victoria N Panfilova  6 , Natalia V Rogozina  7 , Anatoly I Khavkin  3 , Elena L Tumanova  8 , Giuseppe Indolfi  9 , Claire Thorne  10
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Advanced liver disease in Russian children and adolescents with chronic hepatitis C

Anna Turkova et al. J Viral Hepat. 2019 Jul.

Abstract

Russia has one of the highest prevalences of paediatric chronic hepatitis C infection (CHC). Our aim was to provide a detailed characterization of children and adolescents with CHC including treatment outcomes. Thus, an observational study of children with CHC aged <18 years was conducted in three hepatology centres from November 2014 to May 2017. Of 301 children (52% male), 196 (65%) acquired HCV vertically, 70 (23%) had a history of blood transfusion or invasive procedures, 1 injecting drug use and 34 (11%) had no known risk factors. Median age at HCV diagnosis was 3.1 [interquartile range, IQR 1.1, 8.2] and 10.8 [7.4, 14.7] at last follow-up. The most common genotype was 1b (51%), followed by 3 (37%). Over a quarter of patients (84, 28%) had raised liver transaminases. Of 92 with liver biopsy, 38 (41%) had bridging fibrosis (median age 10.4 [7.1, 14.1]). Of 223 evaluated by transient elastography, 67 (30%) had liver stiffness ≥5.0 kPa. For each year, increase in age mean stiffness increased by 0.09 kPa (95% CI 0.05, 0.13, P < 0.001). There was significant correlation between liver stiffness and biopsy results (Tau-b = 0.29, P = 0.042). Of 205 treated with IFN-based regimens, 100 (49%) had SVR24. Most children (191, 93%) experienced adverse reactions, leading to treatment discontinuation in 6 (3%). In conclusion, a third of children acquired HCV via nonvertical routes and a substantial proportion of those with liver biopsy had advanced liver disease. Only half of children achieved SVR24 with IFN-based regimens highlighting the need for more effective and better-tolerated treatments with direct-acting antivirals. Further studies are warranted in Russia on causes and prevention of nonvertical transmission of HCV in children.

Keywords: Russia; adolescent; biopsy; child; chronic hepatitis C; elastography; liver fibrosis.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Age at transient elastography (TE) by degree of liver stiffness. Association between age and liver stiffness measured using TE in 223 children with HCV in Russia. There was a significant positive association between age and liver stiffness (r = 0.22, P = 0.001)
Figure 2
Figure 2
Comparison of liver stiffness measured using transient elastography (TE) and fibrosis stage from liver biopsy. Association between liver stiffness measured using TE and fibrosis stage determined from liver biopsy in 34 children with HCV in Russia who had a liver biopsy within 1 y of a TE. There was a significant correlation between liver stiffness and biopsy results (Tau‐b = 0.29, P = 0.042)
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