Clinical and laboratory characteristics of chronic hepatitis C in children with different levels of aminotransferases

Aminotransferases reflect the volume and degree of liver damage with the development of inflammation in chronic hepatitis C, correlate with fibrosis, therefore their determination in such patients is of both scientific and practical importance. The aim of the study is determination of the clinical course, dynamics of laboratory and instrumental parameters in children with HCV who received direct antiviral therapy, depending on the initial level of aminotransferases in blood serum. Materials and methods. 36 patients aged 3—16 years were under observation, randomized depending on the level of aminotransferases in the blood serum. All children underwent a regulated clinical, laboratory and instrumental examination before starting treatment with the direct antiviral drug glecaprevir/pibrentasvir, 12 weeks and 6 months after the start of the course of therapy. Results. Patients with high levels of aminotransferases were more likely to become infected with HCV perinatal compared with children with normal levels of these enzymes in the blood serum. The age and clinical symptoms in both groups did not differ. Aminotransferases were initially elevated in 27.8% of children with chronic hepatitis C, while their maximum level did not exceed 4 norms. The appointment of a course of direct antiviral therapy with glecaprevir / pibrentasvir contributes to a fairly rapid and stable normalization of aminotransferase levels in all patients in both groups, regardless of their initial amount. HCV genotype 1b prevailed in both children with high levels of aminotransferases and those with normal levels, and the viral load was low in the group with normal levels of aminotransferases. Faster normalization of liver size according to ultrasound data in patients with normal aminotransferase levels under the influence of direct antiviral therapy indicates a direct correlation between the level of aminotransferases and the degree of liver damage in chronic hepatitis C. However, more pronounced fibrosis in 1 child (up to grade F3 on the METAVIR scale) in this group indicates the need for close attention even to those children whose aminotransferase levels remain normal, which does not exclude the course of their fibrotic process in the liver. Conclusion. Thus, it can be assumed that the baseline level of aminotransferases in children with HCV is important for assessing the degree of liver damage and allows predicting the effectiveness of direct antiviral therapy.

1. Bokhonov MS, Galitsina LE, Sitnikov IG, Gorbunova OS. Klinicheskie osobennosti khronicheskogo gepatita C u detey [Clinical features of chronic hepatitis C in children]. Detskie Infektsii=Children Infections. 2023;22(2):23—27. (In Russ.) doi:10.22627/2072-8107-2023-22-2-23-27

2. Volynets GV, Khavkin AI. Sovremennyy vzglyad na lechenie khronicheskogo gepatita C u detey i podrostkov [Modern view on the treatment of chronic hepatitis C in children and adolescents]. Rossiyskiy Vestnik Perinatologii i Pediatrii. 2019;64(6):11—19. (In Russ.) doi:10.21508/1027-4065-2019-64-6-11-19

3. Ferreira J, Sheflin-Findling S. Update on pediatric hepatitis C infection. Curr Gastroenterol Rep. 2025;27:18. doi:10.1007/s11894-024-00955-3

4. Curci F, Stinco M, Carrera S, Rubino C, Indolfi G. Diagnostic approach for children with increased serum concentrations of aminotransferases. Glob Pediatr. 2024;7:100118. doi:10.1016/j.gpeds.2023.100118

5. Abdel-Khalek EE, El-Fakhry A, Helaly M, Abdel-Aal I, Zalata K. Alanine aminotransferase levels in Nile delta citizens infected with chronic hepatitis C virus. Eur J Gen Med. 2012;9(4):247—252.

6. Zapata R. Clinical approach to the patient with chronic hepatitis C infection and normal aminotransferases. Ann Hepatol. 2010;9(Suppl 1):S72—S79. doi:10.1016/S1665-2681(19)31728-4

7. Bacon BR. Treatment of patients with hepatitis C and serum aminotransferase levels. Hepatology. 2002;36(5 Suppl 1):S179—S184. doi:10.1053/jhep.2002.36386

8. Sinn DH, Gwak GY, Shin J, Choi MS, Lee JH, Koh KC, et al. Disease progression in chronic hepatitis C patients with normal alanine aminotransferase levels. World J Gastroenterol. 2013;19(14):2256—2261. doi:10.3748/wjg.v19.i14.2256

9. Turkova A, Volynets GV, Crichton S, Skvortsova TA, Panfilova VN, Rogozina NV, et al. Advanced liver disease in Russian children and adolescents with chronic hepatitis C. J Viral Hepat. 2019;26(7):881—892. doi:10.1111/jvh.13093

10. Pokorska-Śpiewak M, Kowalik-Mikołajewska B, Aniszewska M, Pluta M, Walewska-Zielecka B, Marczyńska M. Determinants of liver disease progression in children with chronic hepatitis C virus infection. Pol J Pathol. 2015;66(4):368—375. doi:10.5114/pjp.2015.57248

11. Kanda T, Matsumoto N, Ishii T, Arima S, Shibuya S, Honda M, et al. Chronic hepatitis C: acute exacerbation and alanine aminotransferase flare. Viruses. 2023;15(1):183. doi:10.3390/v15010183

12. Meskina ER, Galkina LA, Tselipanova EE, Odinaeva ND. Kaskad meditsinskoy pomoshchi detyam s infektsiey, vyzvannoy virusom gepatita C, v Moskovskoy oblasti [The cascade of medical care for children with hepatitis C virus infection in the Moscow region]. Zh Mikrobiol Epidemiol Immunobiol. 2022; 99(5): 525—539. (In Russ.) doi:10.36233/0372-9311-330

13. Mihaylova M, Strashilov S, Tonchev P. Value of aminotransferases in liver cirrhosis. J IMAB. 2024;30(4):5824—5828. doi:10.5272/jimab.2024304.5824

14. ur Rehman H, Sarwar M. Aspartate aminotransferase-alanine aminotransferase ratio predicts cirrhosis in patients with chronic hepatitis C. Pak Armed Forces Med J. 2006;56(1):23—27.

15. Giannini E, Risso D, Botta F, et al. Validity and clinical utility of the aspartate aminotransferase-alanine aminotransferase ratio in assessing disease severity and prognosis in patients with hepatitis C virus-related chronic liver disease. JAMA Intern Med. 2003;163(2):218—224. doi:10.1001/archinte.163.2.218

16. Lin MS, Lin HS, Chung CM, Lin YS, Chen MY, Chen PH, et al. Serum aminotransferase ratio is independently correlated with hepatosteatosis in patients with HCV: a cross-sectional observational study. BMJ Open. 2015;5: e008797. doi:10.1136/bmjopen-2015-008797

17. Huynh T, Zhang J, Hu KQ. Hepatitis C virus clearance by direct-acting antiviral results in rapid resolution of hepatocytic injury as indicated by both alanine aminotransferase and aspartate aminotransferase normalization. J Clin Transl Hepatol. 2018;6(3):258—263. doi:10.14218/JCTH.2018.00014

18. Akbar N, Tasneem AA, Khan RTY, Kumar S, Majid Z, Luck NH. Utility of BE3A score in predicting outcome of patients with hepatitis C related decompensated cirrhosis treated with direct acting antiviral therapy. Int J Clin Med Case Rep. 2021;16:382. doi:10.46998/IJCMCR.2021.16.000382

19. Pokorska-Śpiewak M, Dobrzeniecka A, Talarek E, Aniszewska M, Marczyńska M. To treat or not to treat young children with hepatitis C? — reallife experience. Eur J Pediatr. 2025;184:665. doi:10.1007/s00431-025-06517-7