|Budget Amount *help
¥2,000,000 (Direct Cost : ¥2,000,000)
Fiscal Year 1995 : ¥900,000 (Direct Cost : ¥900,000)
Fiscal Year 1994 : ¥1,100,000 (Direct Cost : ¥1,100,000)
The objectives of this study were to clarify whether and how the patient's immunity has any influences on clinical course and pathophysiology of pediatric hepatitis C virus (HCV) infection. In Japan, immunodeficient patients including leukemia, organ transplant recipients, hemophilia account for about half of the pediatric HCV infection and we focused these patients.
First we analyzed a patient with congenital immune-deficiency and chronic hepatitis C,which progressed to liver cirrhosis and finally to hepatic failure 5 years later. Quantification of her sera showed high levels of HCV-RNA,which implied active viral replication. This case clearly indicates that contrary to the widely held view of a benign short-term prognosis in pediatric hepatitis C,progressive fatal liver disease can develop in immunodeficient patients. The details were reported in Eur J Pediat, (1996), titled as Rapidly progressive hepatitis C in a patient with common variable immunodeficiency.
Second, we make a compara
tive study of pediatric hepatitis C between 18 immunesuppressed patients and 14 immunocompetent patients. In immunosuppressed patients, the following features were observed ; 1) Incubation periods between HCV infection through blood transfusion and the development of hepatitis were longer than that in normal persons. One patient developed hepatitis C one and 10 months after blood transfusion, that is, 4 months after completion of anti-leukemia chemotherapy. Liver cell injury in hepatitis C may be influenced by host immunity. 2) The anti-HCV antibody production was delayd or suppressed. 3) Multiple genotypic HCV infection was common. The diagnosis of HCV infection is sometimes difficult in such cases. 4) The serum levels of HCV-RNA in immunosuppressed patients were as high as that in immunocompetent patients. 5) Histological findings of the liver were more progressed.
In conclusion, host immunity has great influence on hepatitis C.In treating such patients, we should take care these points. Less