Epidemiology and Natural History of Childhood-Acquired Chronic Hepatitis C: A Single-Center Long-Term Prospective Study

To prospectively describe the epidemiology and long-term outcome of childhood-acquired hepatitis C virus (HCV) infection in a large cohort of children followed at a single centre. All children with chronic HCV infection followed at the Liver Unit of our tertiary Hospital in Florence (Italy) from January 1st, 1988, to September 30th, 2021, were included in the analysis. The final sample consisted of 163 children (median age at enrolment 4 years, interquartile range - IQR - 10; median age at last follow-up 14 years, IQR 7). The median duration of follow-up was 86 months (IQR 112). One-hundred and twenty-five children were vertically infected and 26 acquired the infection horizontally. Twenty-six of the 125 children who were vertically infected (20.8%) underwent spontaneous clearance of HCV RNA at a median age of 4 years (IQR 2), while all the others remained persistently viraemic. One patient was diagnosed with cirrhosis; 2 presented clinically detectable extrahepatic manifestations (chronic urticaria). Thirty-two children (19.6%) received antiviral therapy: 8/32 (25%) were treated with pegylated-interferon alfa-2b (sustained virological response - SVR - 24 weeks after the end of treatment in 7/8); 24/32 (75%) were treated with direct-acting antivirals (SVR 12 weeks after the end of treatment in 23/24). The present study describes the largest cohort of children with chronic HCV infection prospectively evaluated with a long follow-up at a single centre. HCV infection in children is often a chronic infection which can be cured with modern antiviral therapy. Early treatment could prevent the development of advanced liver disease.