Natural History of Chronic Viral Hepatitis in Childhood


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Author: G. VERUCCHI, M LENZI*, L ATTARD, P MURATORI*, S DIOTALLEVI, R MINERO§, F GUZZO, F BIANCHI*, F CHIODO Dep.of Clinical and Experimental-Division of Infectious Diseases-University of Bologna, *Internal Medicine - University of Bologna, § Dep. of Clinical Pathology- S.Orsola Hospital - Bologna - Italy

The relationship between hepatitis virus infections (HCV and HBV) and autoimmune phenomena (ANA, SMA, anti-LKM1, anti-LC1, a ti-Thyroid-Peroxidase-anti-TPO and anti-Thyroglobulin-anti-TG) are still poorly investigated in children. Aim of the study: to assess the prevalence of non organ and organ specific autoantibodies in a retrospective series of children with HCV and HBV-chronic infection. Patients and Methods: 36 patients with anti-HCV and HCV-RNA positive chronic hepatitis (18 males, 18 females) with a median age of 8.9 years (range 2-15,8) were studied, Twenty-two patients received blood or plasma transfusion, 11 were borm from anti-HCV positive mothers,one had major surgery and in two the route of infection was unknown. As a control group, sera from 42 children (23M/19F) (median age 9,4 years-range 2,5-15,11) with HBV infection (33 HBV-DNA positive) were considered. Sera were tested at a dilution of 1:20 on liver, kidney and stomach cryostat sections and on Hep-2 cell. Anti-LC1 antibody was tested by CIE with rat liver cytosol as source of antigen. Anti-Thyroid Peroxidase and anti-Thyroglobulin antibodies were tested by a commercially RIA-Kit. Results: non organ-specific autoantibodies were detected in 10 out of 36 patients with HCV infection (28%) and in 5 out of 42 children with HBV infection (12%). The prevalence of each autoantibodies is shown in the table

                                   HCV (36)      HBV (42)
     ANA (speckled)        1     3%        2     5%
     SMA (non anti-actin)  5    14%      3     7%
     Anti-LKM1                4    11%       0     -
     Anti-LC1                   0     -           0     -
     Anti-TPO                 1/29   3%      0/27   -
     Anti-TG                    0/29   -         0/27   -

Clinical and biochermical differences did not emerge between autoantibodies positive and negative patients. No specific association was found between HCV genotypes and one of the autoantibodies studied. Four (3 SMA, 1 ANA) out of 12 patients with HCV chronic hepatitis and 1 (ANA) out of 19 children with HBV chronic hepatitis who underwent interferon therapy developed low titres of autoantibodies under treatment. Conclusions: These results demonstrate that overall prevalence of non organ specific autoantibodies is higher in children with HCV -related chronic hepatitis than that observed in HBV -related ones, and similar to that observed in adults. The autoantibodies specificities typical of autoimmune hepatitis were never observed in these patients. Anti-LKM1 reactivity is specific of anti-HCV infection and its prevalence is higher than that reported in adults.

Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting

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