Absence of progressive liver disease after treatment in children with chronic hepatitis C: A nationwide registry study.

Abstract

Objectives: In adults with chronic hepatitis C (CHC) and advanced fibrosis, hepatocellular carcinoma (HCC) surveillance is recommended after achieving a sustained virologic response (SVR). However, post-SVR surveillance strategies for children remain unclear. The aim of this study was to assess the durability of SVR and determine an appropriate follow-up duration by evaluating longitudinal changes in liver enzymes, fibrosis markers, and liver-related complications in children with CHC.

Methods: Using a nationwide annual Japanese registry, we analyzed children with CHC treated with interferon (IFN)-based therapies or direct-acting antivirals (DAAs). Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, platelet counts, AST-to-platelet ratio index (APRI), and liver-related complications were evaluated.

Results: Among the 168 IFN-treated patients assessed 1 year after treatment, 140 (83%) achieved SVR. Although the number of evaluable patients decreased after 5 years of follow-up, all patients who were followed for 5-15 years maintained SVR, and none developed liver cirrhosis or HCC. Compared with pretreatment values, the IFN-SVR group showed significant reductions in serum aminotransferase levels at 1-5 years after treatment. APRI decreased significantly during the first 3 years after SVR and remained stable thereafter. These improvements were consistently observed among IFN-treated patients with mild-to-moderate fibrosis. All 43 evaluable DAA-treated patients achieved SVR and maintained SVR for up to 5 years.

Conclusions: Children with CHC who achieve SVR demonstrate long-term viral eradication and favorable liver outcomes. The stabilization of APRI within 3 years after SVR suggests that follow-up for at least 3 years after SVR may be warranted in most children.