# A Retrospective Description of Pediatric Hepatitis C in a Romanian Cohort: Liver Fibrosis at Diagnosis

## TL;DR

This study examines liver disease severity in children with hepatitis C in Romania, finding notable cases of advanced liver damage despite generally mild symptoms.

## Contribution

The study provides new insights into liver fibrosis prevalence in a Romanian pediatric HCV cohort, emphasizing the need for improved screening.

## Key findings

- 40.6% of children had absent or mild liver fibrosis at diagnosis.
- 33.7% of children had moderate fibrosis, and 8.4% had severe fibrosis or cirrhosis.
- No significant correlations were found between viral load, transaminase levels, and fibrosis severity.

## Abstract

Background: Pediatric hepatitis C virus (HCV) infection is often asymptomatic but may lead to significant liver disease later in life. In Romania, data on pediatric HCV remains scarce. This study aimed to describe the clinical and epidemiological characteristics of children with chronic HCV infection in a Romanian cohort. Methods: We conducted a retrospective study that included 83 pediatric patients evaluated for chronic hepatitis C between 1995 and 2024 at a tertiary pediatric hospital from Bucharest, Romania. Demographic data, routes of transmission, biochemical parameters, viral load, and liver fibrosis assessed by FibroScan® or liver biopsy were analyzed. Results: The median age at diagnosis was 73 months (IQR 36–156), with a slight female predominance (54.2%). Vertical transmission was the most common (48.2%). Most children had normal or mildly elevated transaminases at diagnosis. Although pediatric HCV hepatic involvement is generally considered mild, in our cohort only 40.6% of children had absent or mild fibrosis at diagnosis, while in 33.7% of cases moderate fibrosis was identified, and 8.4% had severe fibrosis or cirrhosis. No significant correlations were found between viral load, transaminase levels, and fibrosis severity. Conclusions: Pediatric HCV infection in Romania is frequently diagnosed late, mainly due to the lack of systematic perinatal screening. Although liver disease is generally mild, the cases of advanced fibrosis highlight the need for early diagnosis and improved screening strategies.