A retrospective study (Hepatology 2013; 58: 1580-86) of liver biopsies from treatment-naive children enrolled in the PEDS-C study confirm the perception that hepatitis C histologic progression is typically slow.
This study examined 35 pediatric patients (84% genotype 1) who had at least two liver biopsies more than a year a part at eight different centers. For this study, all of the liver histology was scored by a single pathologist. Mean age at first and final biopsy were 8.6 and 14.5 years. Mode of transmission: 57% vertical and 39% transfusion.
Results:
- Inflammation was minimal in about 50% at both timepoints.
- Fibrosis was absent in 16% at both timepoints. Fibrosis was limited to portal/periportal in 73% at first biopsy and 64% at second.
- Proportion of patients who had bridging fibrosis/cirrhosis at second timepoint increased from 11% to 20%. Overall, 29.5% (n=13) showed an increase in severity of fibrosis.
- In aggregate, “this cohort did not show significant histologic progression of liver disease over 5 years.”
Implications for treatment per authors: “It may be argued that treatment of a slowly progressing disease in an asymptomatic child may be deferred given the side effects and limitations of the currently available therapy. On the other hand, some might favor early treatment…a liver biopsy …may influence decisions regarding therapy.”
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