Progress and Barriers Towards Elimination of Chronic Hepatitis C in Children.

Chronic hepatitis C (CHC) is a global health burden. Mother-to-child transmission (MTCT) accounts for most HCV infections in pediatric patients. Spontaneous viral clearance may occur in early childhood but is uncommon thereafter. Infection is usually asymptomatic during childhood, although without an effective treatment, vertically infected children may develop serious liver complications including cirrhosis and hepatocellular carcinoma in adulthood. Despite the lack of vaccine against hepatitis C and effective post-exposure methods of prevention of MTCT, treatment with direct-acting antiviral agents (DAAs) raised the prospect of eliminating HCV on a population level. Highly effective, well-tolerated, oral, and interferon-free regimens of short duration have revolutionized treatment of CHC. However, access to these therapies might be limited because of its high cost. In this review, we provide the current state of knowledge on the epidemiology, testing, monitoring and treating of HCV in children. We outline the remaining gaps in therapy and barriers to disease eradication.

Novel serum biomarkers modified by the body mass index z-score for the detection of liver fibrosis and steatosis in children with chronic hepatitis C.

BACKGROUND: There is a need for validation of noninvasive alternatives to liver biopsy for the evaluation of fibrosis in children with chronic hepatitis C (CHC). The aim of this study was to evaluate the diagnostic performance of serum biomarkers modified by the body mass index z-score (BMI z-score) for the detection of fibrosis and steatosis in children with CHC. METHODS: Thirty children aged 9.4 ± 3.7 years (14 males, 16 females) with CHC underwent liver biopsy. Fibrosis was scored using a 5-point METAVIR scale (≥2 = significant fibrosis). For all the children, the following noninvasive markers were calculated: The aspartate transaminase (AST)-to-platelets ratio index (APRI), the modified APRI (M-APRI: BMI z-score × APRI), the Fibrosis-4 index (FIB-4), the modified FIB-4 (M-FIB-4: BMI z-score × FIB-4), and a novel marker, B-AST (BMI z-score × AST). The area under the receiver operator characteristic curve (AUROC) was calculated to detect significant fibrosis and steatosis. RESULTS: In the histopathological evaluation, 22/30 (73%) patients presented with fibrosis, and 8/30 (27%) presented with steatosis. For the detection of significant fibrosis, the AUROCs for M-APRI, M-FIB-4 and B-AST were 0.842, 0.823, and 0.848, respectively. For significant steatosis, the AUROCs were more than 0.9 for all markers that included the BMI z-score. B-AST, with a cut-off of 92.8, showed 71% sensitivity and 95% specificity for detecting significant fibrosis. For predicting severe steatosis, B-AST had 100% sensitivity and 92% specificity. Negative values of all three markers that included BMI z-scores excluded all patients with both significant fibrosis and significant steatosis. CONCLUSIONS: Including the BMI z-score in serum biomarker formulas enhances their diagnostic ability to detect significant fibrosis and steatosis. B-AST may thus act as an effective alternative to liver biopsy.

The influence of hepatitis B and C virus coinfection on liver histopathology in children.

The influence of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on liver histology in children remains unknown. We analyzed histopathological features in 70 treatment-naïve children: 10 with HBV/HCV coinfection (case group A), 30 with HBV (control group B), and 30 with HCV (control group C). Liver biopsies were scored for grading and staging according to Knodell's modified system and were tested for an association with demographic and laboratory data. The mean grade was higher in coinfected children compared to control group C (6.2 ± 3.0 vs. 4.2 ± 2.5, p = 0.04), but not control group B (p = 0.47). A higher proportion of patients with moderate to severe necroinflammation were observed in case group A compared to isolated HCV (p = 0.05). Mean staging did not differ between the case and control groups. Multivariate analysis revealed that HBV/HCV coinfection and aminotransferase activity were independently associated with moderate to severe necroinflammatory activity Conclusion: HBV/HCV coinfection was associated with moderate to severe necroinflammation irrespective of age at biopsy or duration of infection and led to significantly higher necroinflammatory activity than HCV monoinfection. HBV/HCV coinfection did not enhance fibrosis. High aminotransferase levels were positively associated with moderate to severe necroinflammation.

Determinants of liver disease progression in children with chronic hepatitis C virus infection.

Histopathological features and determinants of liver disease progression were analyzed in 42 treatment-naïve children (mean age: 10.7 ±3.7) with chronic hepatitis C (14/42 infected vertically and 26/42 horizontally). Histopathological evaluation was performed according to Knodell's modified system. Predictors of necroinflammation and fibrosis were identified using linear regression analyses. Most children presented with mild necroinflammation and fibrosis (mean grade 4.3 ±2.7, mean staging 1.2 ±0.8), irrespective of the mode of transmission. Vertically infected children were younger than those infected horizontally (8.6 ±2.5 vs. 11.5 ±3.7 years, p = 0.02). Alanine and aspartate aminotransferase (ALT and AST) levels were associated with necroinflammation (p = 0.003 and p = 0.01 for ALT and AST, respectively) and fibrosis (p = 0.01 and p = 0.04, respectively). Other positive independent predictors of fibrosis included duration of infection (p = 0.03) and body mass index (BMI) z-score (p = 0.03). Children with chronic hepatitis C presented with mild liver changes over a decade after the infection, irrespective of the mode of transmission. Since fibrosis is a time-dependent process, progression of the liver disease in vertically infected children may occur at a younger age compared to patients infected horizontally. Aminotransferase levels were associated with necroinflammation and fibrosis. Longer duration of infection and a higher BMI z-score were associated with more severe fibrosis.

[Anti-HCV testing as a basic standard of monitoring HCV mother-to-child infection: advantages and disadvantages of the method]. / Badanie przeciwcial anty-HCV jako podstawowy standard monitorowania zakazenia odmatczynego HCV: zalety i wady metody.

UNLABELLED: Vertical transmission is an important route of HCV infection. Infants are considered to be infected if two or more HCV-RNA results are positive and/or anti-HCV+ over 18 mo of age. HCV-RNA RT-PCR testing requires high quality certificated centers. Anti-HCV ELISA commercial tests are cheaper and may be performed in all laboratories. AIM: To estimate sufficiency of anti-HCV testing over 18 mo in the diagnostic process of HCV mother-to-child infection. METHODS: 317 children born to HCV infected mothers were observed for 2-4 years. HCV-RNA was determined first at the age of 2-5 mo and subsequent in 6 months intervals, anti-HCV every 3-6 months. RESULTS: HCV infection (HCV-RNA twice presence) was recognized in 26/317 (8.2%). Anti-HCV+ were found in: 288 (91%) children in 3-6 mo of age, 213 (67.2%) in 7-9 mo, 21 (6.6%) above 18 mo. HCV-RNA was negative during all observation in the group with anti-HCV results group in all determinations in the first year of life. Among 21 children anti-HCV+ over 18 mo there were: 18 with chronic infection (HCV-RNA+, anti-HCV+), 3 achieved HCV-RNA clearance (2 became anti-HCV-, 1 anti-HCV+ during following observation). Among 296 children anti-HCV over 18 mo there were 5 children HCV-RNA+ twice in the first year of life, but all became HCV-RNA- during follow up. In 4 of them (4/296, 1.3%) in spite of anti-HCV- we transiently found HCV-RNA+ above 18 mo of age. CONCLUSIONS: Anti-HCV presence in children born to HCV infected mothers: a) up to 18 mo of age do not confirm HCV infection. b) over 18 mo of age are indicative of HCV infection, but not always with active HCV replication. Negative results of anti-HCV above 18 mo of age usually allow us to exclude HCV replication, but in 1.3% we found HCV-RNA in anti-HCV- children. Anti-HCV testing over 18 mo of age as only diagnostic procedure may be not enough. Missing HCV replication in the first period of life prevents HCV microreplication follow up.

Pegylated interferon and ribavirin gone but not forgotten in the era of direct-acting antivirals.

BACKGROUND: Therapy with pegylated interferon and ribavirin (PEG-IFN+RBV) for chronic hepatitis C (CHC) remains the only option available for children in many Eurasian and European countries. Our aim was to evaluate the influence of host and viral factors on response to IFN-based therapy to optimize it for those in whom directly acting antivirals (DAA) are currently unavailable. METHODS: Seventeen vertically infected, treatment naive children (10 male and 7 female) aged 5-16 years with CHC underwent a course of PEG-IFN+RBV. The end point was sustained virologic response (SVR). Host and virus factors were divided into pre- and on-treatment predictors of response to therapy. RESULTS: Eleven patients obtained SVR (64%), 4 were non-responders (23%), and 2 were relapsers (12%). Significant relationship was found between HCV RNA elimination and following variables: virus genotype and early virologic response (EVR) (P<0.037, P<0.029 respectively). Higher eradication rate was observed in patients infected with genotype 3 HCV (100% vs. 65% with genotype 1 or 4), and in those with undetectable HCV RNA by week 12 (88% vs. 66% with viremia). EVR was associated with SVR (83% vs. 0% in nonresponders; P<0.004). C allele of IL28B rs12979860 was a predictor of EVR (P<0.043). The SVR rates among CC, CT, and TT carriers were as follows: 75%, 67%, and 33%. CONCLUSIONS: Detection of favorable HCV and IL28B genotype prior to commencement of PEG-IFN+RBV and continuing it in patients with EVR is of major importance for those in whom DAA are still unavailable.

Comparison of clinical severity and epidemiological spectrum between coronavirus disease 2019 and influenza in children.

Data on the novel coronavirus disease 2019 (COVID-19) in children are limited, and studies from Europe are scarce. We analyzed the clinical severity and epidemiologic aspects of COVID-19 in consecutive children aged 0-18 years, referred with a suspicion of COVID-19 between February 1, and April 15, 2020. RT-PCR on a nasopharyngeal swab was used to confirm COVID-19. 319 children met the criteria of a suspected case. COVID-19 was diagnosed in 15/319 (4.7%) patients (8 male; mean age 10.5 years). All of them had household contact with an infected relative. Five (33.3%) patients were asymptomatic. In 9/15 (60.0%) children, the course of the disease was mild, and in 1/15 (6.7%), it was moderate, with the following symptoms: fever (46.7%), cough (40%), diarrhea (20%), vomiting (13.3%), rhinitis (6.7%), and shortness of breath (6.7%). In the COVID-19-negative patients, other infections were confirmed, including influenza in 32/319 (10%). The clinical course of COVID-19 and influenza differed significantly based on the clinical presentation. In conclusion, the clinical course of COVID-19 in children is usually mild or asymptomatic. In children suspected of having COVID-19, other infections should not be overlooked. The main risk factor for COVID-19 in children is household contact with an infected relative.

[Mother-to-infant HCV transmission. Can we influence the frequency and the course of the infection?]. / Zakazenie odmatczyne HCV--czy mozemy miec wplyw na czestosc zakazenia i jego przebieg?

AIM: To estimate the management of HCV infected women and their children. METHODS: Part I/: Blood samples were collected from 544 pregnant women and tested for anti-HCV. Part II/: Data of risk factors of HCV infection, reasons of HCV diagnostics were assessed in 281 mothers infected with HCV, not infected with HIV. 317 children born to HCV infected mothers were observed from birth until age 2.5-10 years (testing of HCV-RNA, ALT). 26 (8.%) of them were infected with HCV. RESULTS: Part I/: 22.02% of tested pregnant women were anti-HCV(+). Part II/: Presence of risk factors for HCV infection in anamnesis was the reason of HCV diagnostics in 34% of women. None of HCV-RNA(-) women transmitted HCV to their child. The rate of HCV infection in infants born to HCV-RNA(+) mothers was 14.1% and was higher in case of natural delivery (19.2%) compared to cesarean section (7.5%). Intrapartum percutaneus exposure to maternal blood increased transmission rates. All children born via elective cesarean section (in 38 Hbd) were HCV-RNA(-). None of infected children had clinical symptoms of hepatitis, however, one of them had mild changes in liver histopathology. CONCLUSIONS: Antenatal screening of anti-HCV is not necessary, however, every woman with risk factors for HCV infection in anamnesis should be tested. Women infected with HCV ought to be treated before pregnancy in order to decrease HCV replication. The protective role of elective cesarean section requires further investigation. A number of children with chronic HCV infection should be considered for early treatment.

[Seroprevalence of anti-HCV in pregnant women. Risk factors of HCV infection]. / Czestosc wystepowania przeciwcial anty-HCV u kobiet ciezarnych. Analiza czynników ryzyka zakazenia HCV.

UNLABELLED: Vertical transmission seems to be an important mode of infection in children. Approximately 6-9% of hepatitis C virus-positive women transmit HCV to their offsprings. AIM: 1. To determine the frequency of HCV infection in pregnant women in central Poland. 2. To estimate knowledge about HCV infection in childbearing women. 3. To identify risk factors for HCV infection among pregnant women. METHODS: Study in two separate parts. Part A: Blood samples were collected from 544 pregnant women, tested with anti-HCV ELISA third generation tests. Part B: Data of risk factors of HCV infection, reason of diagnostics were assessed through structured interview and review of available medical records in 281 women infected with HCV. RESULTS: Part A: 2.02% of tested pregnant women were anti-HCV(+). One of them (1/11) knew about her HCV infection before examination. Part B. 24% of 281 infected women indicate a history of blood products transfusion (all before 1992), 23%- hospitalisation with surgical procedures, 15%--intravenous drug use, 8%--hospitalisation without surgical procedures, 7%--exposures of health care personnel, 3%--infected mother, 3%--sexual partner or other member of family infected with HCV. Histories taken from 17% women did not include any known risk factors. HCV infection in women were diagnosed: before pregnancy in 186 (66%), during pregnancy in 61 (22%), after delivery in 34 (12%). All women were Caucasian, Polish nationality. CONCLUSION: The seroprevalence of anti-HCV in pregnant women was 2.02%. There is a number of childbearing HCV infected women who are not identified as HCV positive. Selective HCV testing to women at high risk of HCV infection and antiviral therapy should be encouraged prior to conception.

Hepatitis C infection among pregnant women in central Poland: Significance of epidemiological anamnesis and impact of screening tests to detect infection.

BACKGROUND: Mother-to-child transmission is one of the main sources of hepatitis C virus (HCV) infection in children. However, because of the asymptomatic course of the illness, certain women may not be aware of their infection. OBJECTIVES: The aim of this study was to estimate the significance of epidemiological anamnesis in diagnoses of HCV infection in women of reproductive age and to evaluate how screening among pregnant women impacts the detection of HCV infection. MATERIAL AND METHODS: Epidemiological interviews of 432 mothers infected with HCV (but free of human immunodeficiency virus (HIV)) were conducted in the Warsaw Hospital for Infectious Diseases (Poland) from 1998 to 2012. RESULTS: Complaints or abnormalities in laboratory tests were the reasons for anti-HCV antibody testing in 28.2% of mothers, whereas specific interview responses or occupational health care services group affiliation were the reasons for testing in 35.6%. However, in a large group of women, infection was only detected because of screening examinations. The introduction of routine screening for pregnant women (since 2010 in Poland) has led to the increased detection of HCV infection in women who did not present with infection risk factors (9.9% before 2010 vs 46.1% after 2010). This practice has also led to an increase in the percentage of women diagnosed during pregnancy (21.5% before 2010 vs 30.8% after 2010). CONCLUSIONS: Establishing HCV infection risk factors during the interview process is the most common indicator for serological testing; however, not all infected cases can be diagnosed in this manner. Screening for anti-HCV antibodies in pregnant women increases the detection of HCV infection in this group.

[Mother-to-infant HCV transmission--rate and course of HCV infection in children]. / Zakazenie wertykalne HCV--ocena czestosci i przebiegu zakazenia u dzieci.

OBJECT: to establish the rate and course of HCV infection in infants born to HCV infected mothers and to determine abilities of prevention. METHODS: 155 children born to HCV infected mothers were observed from birth until age 18-48 months. Serum of infants was tested for HCV-RNA (RT-PCR, Amplicor v 2.0 Roche), for anti-HCV (EIA v. 2) and ALT activity. Infants were classified as HCV infected if their serum was found to be positive for HCV-RNA at least twice during first year of life. In 11 mothers and their newborns serum and PBMC from venous blood and from the umbilical cord were collected during delivery and examined-using nested RT-PCR. RESULTS: The overall HCV vertical infection rate was 11%. Transmission occurred more frequently in children with intrapartum exposure to maternal blood by percutaneus inoculation. None of the infected infants had clinical symptoms of hepatitis. ALT abnormal activity was detected in 43% of infected children. HCV-RNA was detected in mothers' serum and PBMC collected during delivery in 9 (9/11) samples. HCV-RNA was detected in samples from umbilical cord in serum in 7 (7/11) and in PBMC in 4 (4/11) cases. CONCLUSIONS: The risk of HCV vertical infection in present study was high. Intrapartum percutaneus exposure to maternal blood increased transmission rates. Further investigation to determine the effectiveness of antiviral therapy in prevention of mother-to-infant HCV transmission should be performed. The role of PBMC in mother-to-child HCV transmission should be investigated.

Non-invasive evaluation of the liver disease severity in children with chronic viral hepatitis using FibroTest and ActiTest - comparison with histopathological assessment.

AIM OF THE STUDY: Was to evaluate liver disease severity in children with chronic viral hepatitis using the FibroTest and ActiTest (FT/AT), and compare the results with the liver biopsy. MATERIAL AND METHODS: The study included 11 treatment-naïve children [mean age, 9.0 ± 3.0 years, 10 infected with hepatitis C virus (HCV), and 1 with hepatitis B virus (HBV)] who underwent an FT/AT. Ten of the children underwent a liver biopsy. The histopathological evaluation was based on the METAVIR scoring system. The FT/AT and METAVIR scores were considered concordant if the necroinflammatory activity or the fibrosis did not differ by more than one grade or stage. To analyze the agreement between the FT/AT and the histopathological evaluation, the inter-rater agreement (kappa) was used. RESULTS: In the histopathological evaluation, most children presented with mild necroinflammatory activity (METAVIR A1) and with minimal to mild fibrosis (METAVIR F1-2). Both the AT and FT values did not show any linear increases with advancing METAVIR scores A and F, respectively. A discordance between the FT and METAVIR scores was observed in 3/10 (30%) cases; concordance between the AT and METAVIR scores was found in 9/10 cases. The inter-rater agreement test showed poor agreement between the FT/AT and the histopathological evaluation (kappa for AT: 0.0667, and kappa for FT: 0.176). CONCLUSIONS: The FT and AT values poorly correlate with histopathological evaluation. Further studies on non-invasive methods to evaluate liver disease severity in children with chronic viral hepatitis are needed.

Clinical usefulness of new noninvasive serum biomarkers for the assessment of liver fibrosis and steatosis in children with chronic hepatitis C.

AIM OF THE STUDY: Recently, novel serum markers modified by the body mass index z-score (BMI z-score) were proposed as a reliable noninvasive alternative for the detection of significant fibrosis and steatosis in children with chronic hepatitis C (CHC). The aim of this study was to evaluate the clinical usefulness of these biomarkers. MATERIAL AND METHODS: Thirty children aged 9.4 ± 3.7 years (14 males, 16 females) with CHC were included in this study. In all patients, histopathological evaluation of the liver fibrosis was performed using a 5-point METAVIR scoring system (≥ 2 points = significant fibrosis). Significant steatosis was diagnosed with > 33% of hepatocytes affected. The following noninvasive markers of liver disease were calculated: the modified aspartate transaminase (AST)-to-platelet ratio index (M-APRI: BMI z-score × APRI), the modified Fibrosis-4 index (M-FIB-4: BMI z-score × FIB-4), and a novel marker, B-AST (BMI z-score × AST). The clinically useful cut-offs for each marker were selected as simple round numbers, indicating significant fibrosis and steatosis. RESULTS: Significant fibrosis was detected in 7/30 (23%) cases, and significant steatosis was observed in 4 (13%) patients. Comparison with the histopathological evaluation revealed that B-AST < 0 excluded significant fibrosis, and < 100 excluded all patients with significant steatosis. For the M-APRI, < 0 excluded significant fibrosis, and < 0.5 excluded significant steatosis. For the M-FIB-4, < 0 excluded significant fibrosis and < 0.2 excluded significant steatosis. CONCLUSIONS: Negative values of all three markers that included the BMI z-score excluded all patients with both significant fibrosis and significant steatosis.

Liver steatosis in children with chronic hepatitis B and C: Prevalence, predictors, and impact on disease progression.

Only scarce data on liver steatosis in children with chronic hepatitis B and C (CHB and CHC) are available. The objective of this study was to evaluate the prevalence, predictors, and impact of hepatic steatosis on children with CHB and CHC. A total of 78 patients aged 11.5 ±â€Š3.4 years were included: 30 (38%) had CHB, and 48 (62%) had CHC. Steatosis was scored on a 5-point scale, as follows: absent; minimal (≤5% hepatocytes affected), mild (6-33%), moderate (34-66%), and severe (>66%). Stepwise logistic regression was used to determine the factors associated with steatosis and moderate-to-severe steatosis. Steatosis was observed in 4/30 (13%) patients with CHB and 13/48 (27%) patients with CHC (P = 0.17). Moderate-to-severe steatosis was observed in 6/78 (8%) patients: 1/30 (3%) had CHB and 5/48 (10%) had CHC (P = 0.40). The body mass index (BMI) z-score was positively associated with the presence of steatosis in children with CHB (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 1.02-10.64). In CHC, steatosis occurred more frequently in patients with hepatitis C virus genotype 3 compared with other genotypes (P = 0.002). In patients with non-3 genotype hepatitis C virus, steatosis was associated with the stage of fibrosis (OR = 3.35, 95% CI: 1.01-11.07) and inversely associated with the duration of infection (OR = 0.74, 95% CI: 0.55-0.97). Moderate-to-severe steatosis was positively associated with the BMI z-score (OR = 3.62, 95% CI: 1.22-10.75) and stage of fibrosis (OR = 3.89, 95% CI: 1.05-14.47). Steatosis is a common finding in children with chronic viral hepatitis. It is associated with metabolic factors in CHB, whereas in patients with CHC, metabolic and viral factors may have a combined effect, leading to more advanced grades of steatosis in children with higher BMI z-scores. Moderate-to-severe steatosis is a predictor of advanced fibrosis in children with CHC.

Predictors of Liver Disease Severity in Children with Chronic Hepatitis B.

BACKGROUND: Evaluation of the liver histology is essential for the management of chronic hepatitis B (CHB) in children. OBJECTIVES: The aim of this study was to analyze the histopathological features in children with CHB and compare them with clinical and laboratory data. MATERIAL AND METHODS: The study comprised 30 treatment-naïve children (mean age: 12.8 ± 2.4; mean duration of infection: 11.7 ± 2.5 years; 16/30 HBeAg-positive and 14/30 HBeAg-negative), who underwent a liver biopsy due to CHB. Liver biopsies were evaluated according to the modified Knodell score. RESULTS: A histopathological evaluation revealed mild to severe necroinflammatory activity (mean grading: 5.4 ± 3.2) and fibrosis (mean staging: 1.7 ± 0.9), irrespective of the HBeAg-status, viral load and duration of infection. One case of cirrhosis was observed. A multiple regression analysis revealed that alanine and aspartate aminotransferase (ALT and AST) levels were associated with the necroinflammatory activity (p = 0.001 for ALT, and p = 0.006 for AST). No such correlation for fibrosis was observed; however, children with elevated AST were prone to more advanced fibrosis compared to children with normal AST level (p = 0.01). CONCLUSIONS: Children with CHB presented a wide range of liver changes over a decade after the infection. The severity of liver lesions did not differ according to the HBeAg status, viral load and duration of the infection. ALT and AST levels correlated positively with the inflammatory activity. AST seems to be a better predictor of fibrosis compared to ALT. Liver biopsy is a useful tool in evaluating the severity of liver disease in children with chronic hepatitis B, whereas clinical and laboratory parameters are weak predictors of liver injury.

Is liver biopsy still needed in children with chronic viral hepatitis?

Liver biopsy is a standard method used for obtaining liver tissue for histopathological evaluation. Since reliable serological and virological tests are currently available, liver biopsy is no longer needed for the etiological diagnosis of chronic hepatitis B and C. However, liver histology remains the gold standard as a prognostic tool, providing information about the liver disease progression (grading of necroinflammatory activity and staging of fibrosis) and serving clinicians in the management and therapeutic decisions. In general, histopathological evaluation is indicated before starting the antiviral treatment. Main limitations of the liver biopsy include its invasive and painful procedure, sampling errors and the inter- and intra-observer variability. In addition, indications for the liver biopsy in pediatric patients with chronic viral hepatitis were questioned recently, and efforts have been made toward the development of non-invasive methods as an alternative to the liver biopsy. The most commonly used methods are novel imaging studies (elastography) and combinations of biomarkers. However, to date, none of these tests was validated in children with chronic viral hepatitis. In this review, we present the current status of the liver biopsy in the management of chronic viral hepatitis B and C in pediatric population, including specific indications, complications, contraindications, problems, limitations, and alternative non-invasive methods.

[Effectiveness of vaccination against hepatitis B in HIV infected children]. / Ocena skutecznosci szczepien przeciwko wzw B u dzieci zakazonych HIV.

OBJECTIVE: The aim of the study was to evaluate hepatitis B vaccination effectiveness in HIV infected children. METHODS: 45 children vertically infected with HIV who received hepatitis B vaccination were evaluated. Anti-HBs antibodies were assayed to established vaccination efficiency and were repeated every 6-12 months. No-responders received the next vaccination schedule with doubled dose. Children with antibody levels < 100 IU/ml were boostered. All the children have been receiving HAART. MAIN OBSERVATIONS AND RESULTS: 35/45 (77,8%) children had anti-HBs antibodies > 100 IU/ml, including 20 with anti-HBs antibodies > or = 1000 IU/ml (32 children without immunodeficiency, 2 with moderate and 1 with severe immunodeficiency). Anti-HBs level 8-100 IU/ml was observed in 6/46 (13,3%) children (5 children without immunodeficiency and 1 with severe immunodeficiency). 4/46 (8.9%) children had no anti-HBs antibodies (2 children without immunodeficiency, 1 with moderate and 1 with severe immunodeficiency). CONCLUSIONS: In HIV infected children anti-HBs antibodies should be assayed to establish hepatitis B vaccination efficiency and repeated every 6-12 months.

[Mother-to-child HBV transmission--atypical course of hepatitis B in an infant]. / Zakazenie wirusem B zapalenia watroby odmatczyne--nietypowy przebieg u niemowlecia.

UNLABELLED: The article presents the course of hepatitis B transmitted from mother to her child. In the nine-week-pregnant mother HBsAg was not detected, but five months after delivery chronic stage hepatitis B was diagnosed. The infant was vaccinated twice against HBV without HBIG. At six months of age, the infant developed acute hepatitis B and Gianotti-Crosti syndrome (GCS) with high level of aminotransferase activity. In the 2nd year of life seroconversion in the HBe system and reduction of hepatitis B activity was observed. CONCLUSIONS: 1. The double HBsAg test in pregnant women may increase the detectability of HBV infection. 2. Current prophylaxis of HBV infection is not sufficient to protect mother-to-child transmission. 3. Spontaneous regression of acute hepatitis B in infants may occur in the period of more than 6 months from the onset, that is in the chronic stage.

[Response to hepatitis B vaccine in infants with mother-to-child HCV infection]. / Odpowiedz na szczepienie przeciw wzw B u niemowlat zakazonych wertykalnie HCV.

UNLABELLED: The aim of the study was to establish the vaccination-induced anti-HBs seroconversion in a group of children with mother-to-child HCV infection. MATERIAL AND METHODS: 105 infants born to HCV infected mothers were vaccinated against hepatitis B virus (10 microg/ml; 0, 1, 6 months). HCV infection (HCV-RNA RT-PCR, Abbot Laboratories, in serum positive infants detected twice in the first year of life) was confirmed in 18 (group A). 87 infants were HCV uninfected (group B). Anti-HBs titers (Ortho-EIA) were measured 1-6 months after the third dose of immunisation. RESULTS: Seroconversion to anti-HBs >10 mIU/ml was achieved in 93 (88.6%) infants: 13/18 (73%) in group A, 80/87 (92%) in group B. Anti-HBs <10 mIU/ml was observed in 12 (11.3%) children: 5 (27%) in group A, and 7 (8%) in group B (p=0.04). CONCLUSION: Response to hepatitis B vaccine in infants infected with HCV was weaker than in nonvaccinated infants.