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• W4242298162 abstract "We thank Iorio et al. for their interest in our work and for making us aware of their study,1 which included some information on liver biopsies in 64 children. Their findings support those of our and other series, namely that chronic hepatitis C in children is generally histologically mild but may occasionally result in advanced fibrosis and cirrhosis. By design, our own study excluded children with decompensated cirrhosis, so if anything, our collection of liver biopsies could have been biased toward more mild disease. None of the patients in the study by Iorio et al. initially had cirrhosis, but it is noteworthy that three children (5.2%) in that series, ages 2.1, 2.7, and 13.6 years, already had Ishak stage 4 fibrosis, which is defined as marked bridging fibrosis.2 Furthermore, one child in that series, who was initially stage 2, progressed to stage 5 (incomplete cirrhosis) on subsequent biopsy after failing antiviral therapy. Although not observed in the reported large series, there are even reports of hepatocellular carcinoma following hepatitis C acquired in childhood.3, 4 All observers agree that a minority of patients with hepatitis C will progress to cirrhosis and its complications, and although there are known risk factors for progression, it is impossible to know for certain which patients will progress. The fact that some children already have advanced fibrosis, even with a short duration of disease and with no obvious clinical differences from the rest, can only lead to the conclusion that an unknown proportion of others will eventually have the same outcome if there is not an effective therapeutic intervention. Zachary D. Goodman*, Hala R. Makhlouf*, Lea Liu , William Balistreri , Regino P. Gonzalez-Peralta?, Barbara Haber?, Maureen M. Jonas**, Parvathi Mohan , Jean P. Molleston , Karen F. Murray??, Michael R. Narkewicz??, Philip Rosenthal11, Lesley J. Smith12, Kathleen B. Schwarz13, * Armed Forces Institute of Pathology and Veterans Administration Special Reference Laboratory for Pathology, Washington, DC, Maryland Medical Research Institute, Baltimore, MD, University of Cincinnati, Cincinnati, OH, ? University of Florida, Gainesville, FL, ? Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, ** Children's Hospital Boston, Boston, MA, George Washington University, Washington, DC, Indiana University, Indianapolis, IN, ?? University of Washington, Seattle, WA, ?? University of Colorado, Denver, CO, 11 University of California, San Francisco, CA, 12 Columbia University, New York, NY, 13 Johns Hopkins University, Baltimore, MD." @default.
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• W4242298162 date "2008-08-01" @default.
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• W4242298162 title "Reply:" @default.
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• W4242298162 doi "https://doi.org/10.1002/hep.22405" @default.
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