For decades, children and adults who appeared at a doctor’s office with a swollen liver or abnormal liver tests and who tested negative for the two major hepatitis viruses – hepatitis A and hepatitis B – were simply lumped as having non-A non-B hepatitis, a condition with few specific treatment options.
All that changed with the discovery in the 1970s of what is now known to be the hepatitis D virus, followed in 1989 by that of the hepatitis C virus (HCV). Both viruses cause their own progressive and slow disease and requires their own approaches to treatment and care. (Two more hepatitis viruses – lettered E and G – have since been found to also cause primary liver disease in people.)
Hepatitis C is now recognized as a significant liver disease affecting some 3 percent of all children worldwide. There are between 20,000 and 40,000 new cases of hepatitis C in the United States each year, the variability stemming from the fact that because most children and adults with hepatitis C feel no specific symptoms; many do not even know they are infected.
In the past HCV was primarily passed through blood transfusions, but today the most common route by which a child might be infected with the virus is at birth from an infected mother. It is important to note, though, that this is still an uncommon event; a woman with hepatitis C has about a 1 in 20 (5 percent) chance of passing the virus on to her child. To put this in perspective, the risk of a woman with HIV passing that virus on to her child is upwards of 45 percent, according to the World Health Organization; for hepatitis B, the risk can be up to 90 percent.
There are two phases of hepatitis C: acute and chronic. Acute hepatitis C is a mild illness that children and adults experience within the first six months of infection. Most people with acute hepatitis C have no symptoms. As many as a quarter of children infected with HCV clear the virus on their own without any treatment during the acute phase. Those who do not clear the virus progress on to chronic hepatitis C, a serious, long-term illness that can over the course of decades damage the liver to the point that a transplant becomes necessary.
There is treatment available for children with chronic hepatitis C: a combination of two drugs called peginterferon and ribavirin. The course of treatment that our doctors would recommend depends on which of the six genetic types, or genotypes, of the virus a child is carrying. Some of these genotypes are more common in the United States, while others are found more often in other parts of the world.
How Boston Children's Hospital approaches hepatitis C
The Center for Childhood Liver Disease at Boston Children's Hospital is one of the leading centers internationally for the care of children with hepatitis C. In addition to the standard treatments, our team of certified pediatric hepatologists is also at the forefront of treatment research, actively working to help make newly approved treatments for adults with hepatitis C available to children. They are well versed in the nuances of the different treatment and care requirements for each of the six different HCV genotypes.
Hepatitis C: Reviewed by Maureen Jonas, MD
© Children’s Hospital Boston, 2012