Perinatal HCV tied to earlier cirrhosis

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Takeaway

  • Perinatal HCV infection is tied to earlier development of cirrhosis, underscoring the importance of early treatment. 

Why this matters

  • Progression to hepatocellular carcinoma (HCC), liver transplant (LT), or death almost exclusively occurred in patients cirrhotic at treatment onset.

Study design

  • Retrospective U.K. analysis of 1049 HCV-infected children.
  • Funding: Medical Research Foundation.

Key results

  • Main routes of infection: intravenous (IV) drug use (IVD: 53%; median age, 16 years), blood products (24%; 11 years), perinatal infection (11%).
    • Median 19-24 years delay to diagnosis with non-perinatal transmission.
  • 32% developed cirrhosis (median age, 33 years).
    • Lower median age with perinatal vs IVD or blood exposure (36 vs 48 and 46 years, respectively; P<.001 despite low prevalence of risk factors gender or="1.6" and heavy alcohol use>
  • 663 patients (63.2%) received peginterferon/ribavirin (55%) or direct-acting antivirals (40%);
    • 75.0% with available data (406/541) achieved sustained virologic response, which was tied to reduced mortality (1% vs 5%; P=.003).
  • 87 of 502 patients with data had disease progression, more common with cirrhosis (28% vs 13%; P<.001>
  • Pretreatment cirrhosis yielded higher rates of HCC (14% vs 1%; P<.001 vs p=".005)," and death>

Limitations

  • 85% of perinatally infected were under age 33 at analysis.