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

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[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(31%). 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 (TE), 67(30%) had liver stiffness ≥5.0kPa. For each year increase in age mean stiffness increased by 0.09kPa(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 non-vertical 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 non-vertical transmission of HCV in children. This article is protected by copyright. All rights reserved