treatment of chronic hepatitis c in young children is controversial because of spontaneous hcv clearance and possible adverse events . vertical hcv genotype 1 infection was diagnosed in a 3-month - old infant . in the subsequent clinical examination we still observed hepatomegaly , fluctuations of alt , ast and ggt activity , with the highest values 2206 u / l , 1319 u / l , and 297 u / l , respectively . in qpcr , in the 42nd week of observation , liver biopsy was performed with grade 1 grading and grade 1 staging . at age 12 months , interferon - alpha2b ( 1.5 mu 3 times a week ) and ribavirin ( 280 mg daily ) were administered for 48 weeks . at the beginning of the treatment we observed fever after ifn injection . in the 12 week of therapy , hcv rna disappeared followed by svr , and it was sustained for 6 years . to our knowledge , this is the first report of a pediatric ( 1-year - old ) patient treated with combined ifn alpha-2b and ribavirin therapy . this case report confirms the possibility of successful anti - hcv treatment in a young child , with 6-year sustained virological response without significant adverse events . in poland the number of persons with chronic hcv infection is estimated at 700 000 . while parenteral transmission is still common in polish patients , perinatal transmission now seems to be the leading cause of hcv transmission in children . maternal factors cited as playing a significant role in hcv vertical transmission include : high hcv viral load , hiv / hcv coinfection , intravenous drug use , certain hla types , and the presence of hcv rna in maternal peripheral blood mononuclear cells and advanced hcv - liver disease in the mother [ 24 ] . it commonly is an asymptomatic chronic infection , with normal alanine aminotransferase ( alt ) activity and minor abnormalities of liver histology , most often diagnosed incidentally or as a result of epidemiological investigation . spontaneous hcv clearance can occur in up to 2530% of children , especially those infected with genotype 3 hcv , and the rate of clearance is independent of the mode of hcv transmission . it appears that the probability of persistent viremia and development of end - stage liver disease is relatively higher in children infected with genotype 1 hcv and in those who have acquired disease via vertical transmission . treatment of chronic hepatitis c in young children is controversial because of spontaneous hcv clearance and possible adverse events . we report a case of vertical hcv genotype 1 infection successfully treated in the second year of life , with sustained response for 6 years . a 3-month - old infant , who was born in 40 hbd , second pregnancy , with weight 3200 g , was hospitalized because of diarrhea and vomiting . past medical history revealed that his mother was admitted to the hospital because of acute hepatitis c 5 days after delivery . physical examination revealed hepatosplenomegaly , with enlarged liver ( 4 cm ) and spleen ( 1 cm ) . in laboratory testing we detected elevated aminotransferases activity ( alt 82 u / l , ast 92 u / l ) . serum levels of bilirubin , ggt , and prothrombin ratio were within normal limits . the child was vaccinated against hbv and the anti - hbc total test result was negative . serologic testing revealed the presence of anti - hcv antibodies , and hepatitis c was confirmed by detection of hcv rna with pcr method . in the differential diagnosis of hepatitis we excluded hav , ebv , and cmv infections and toxoplasma gondii , as well as wilson s disease , alpha-1 antitrypsin deficiency , and amino acids metabolic disorders . parallel to hematological diagnostics , we looked for the diarrhea etiology and found rotaviruses in stool . the infant was diagnosed with vertical hcv infection and rotavirus diarrhea . in the first days of hospitalization , we observed vomiting and loose stools without disorders of water balance or electrolyte and acid - alkaline equilibrium . after 4 days the patient was discharged in good clinical condition with recommendation for systematic follow - up at the hepatology clinic . during the following 40 weeks fluctuations of alt , ast , and ggt activity showed highest values of 2206 u / l , 1319 u / l and 297 u / l , respectively . in quantitative hcv rna test ( pcr ) , the value of viral load was > 700 000 iu / ml ( > upper limit of detection ) , and hcv genotype 1b with inno - lipa test was detected . at the same time , investigations performed in his mother revealed similar results , confirming diagnosis of vertical hcv infection in the infant . in the 42 week of observation , liver biopsy was performed . histological diagnosis of chronic hepatitis c was established , with grade 1 inflammatory activity ( grading ) , and grade 1 fibrosis ( staging ) according to the modified scheuer s scale . in the 12 month of life , treatment with interferon - alpha2b ( 1.5 mu 3 times a week ) and ribavirin ( 280 mg daily ) was administered . the patient was treated with this combined therapy for 48 weeks . at the beginning of the treatment we observed fever after ifn injection . we observed the disappearance of hcv rna followed by svr and it has been sustained for 6 years ( table 2 ) . in that year , il28b single nucleotide polymorphism rs12979860 and rs8099917 were determined in the child and his mother , and the analysis revealed in both of them the presence of cc , and tt polymorphism , respectively , with favorable response to treatment . we have described a patient with vertically transmitted hcv genotype 1 infection . to our knowledge this is the first report of a pediatric ( 1-year - old ) patient treated with combined ifn alpha-2b and ribavirin therapy . some authors believe that interferon therapy should not be given to children younger than 3 years of age because of the high rate of spontaneous viral clearance and possible adverse events , especially potential neurotoxicity and growth inhibition [ 811 ] . spontaneous clearance of hcv can occur in up to 2530% of children ; younger age at follow - up and alt within normal limits favor hcv clearance . on the other hand , farmand et al , on the basis of alt activity dynamics , suggested that in vertically hcv - infected children a potent inflammatory response in the liver precedes viral clearance and temporarily elevated liver function tests , followed by a decline of viral load , may be indicative of a near viral clearance in early childhood . ruiz - extremera et al showed that il28b cc child polymorphism is independently associated with the spontaneous clearance of hcv genotype-1 among infected children . in the presented case , the decision about treatment was based on elevated lfts , still hcv rna serum presence and histological changes in the liver suggested chronic hepatitis c. it was maintained by the analysis of hepatitis c treatment efficacy , which revealed higher svr rates and fewer adverse events reported in children compared to adults . now , after 6 years , our decision turned out to have been correct , confirmed by sustained viral response and the lack of late adverse events of interferon therapy as growth disorders . this child s mental development is normal and his weight and height are between the 50 and 75 percentiles . despite a generally asymptomatic course of hcv infection in children with mild histological changes in the liver , chronic hepatitis c may lead to liver fibrosis , cirrhosis , and even hcc in children and adolescents . bortolotti et al described end - stage liver disease in 1.8% of analyzed children , who were mainly infected perinatally with hcv genotype 1 . according to wirth et al , about 5% of affected children develop significant liver disease in childhood . anti - hcv treatment helps prevent unfavorable clinical consequences like liver cirrhosis or hepatocellular carcinoma . this case report confirms the possibility of successful anti - hcv treatment in a young child , with a 6-year sustained virological response without significant adverse events .
summarybackgroundperinatal hcv transmission appears to be an important cause of hcv in children . 
 treatment of chronic hepatitis c in young children is controversial because of spontaneous hcv clearance and possible adverse events.case reportvertical hcv genotype 1 infection was diagnosed in a 3-month - old infant . in the subsequent clinical examination we still observed hepatomegaly , fluctuations of alt , ast and ggt activity , with the highest values 2206 u / l , 1319 u / l , and 297 u / l , respectively . in qpcr , 
 hcv rna was > 700.000 iu / ml . 
 in the 42nd week of observation , liver biopsy was performed with grade 1 grading and grade 1 staging . at age 12 months , interferon - alpha2b ( 1.5 mu 3 times a week ) and ribavirin ( 280 mg daily ) were administered for 48 weeks . at the beginning of the treatment we observed fever after ifn injection . in the 12th week of therapy , 
 hcv rna disappeared followed by svr , and it was sustained for 6 years . to our knowledge , this is the first report of a pediatric ( 1-year - old ) patient treated with combined ifn alpha-2b and ribavirin therapy.conclusionsthis case report confirms the possibility of successful anti - hcv treatment in a young child , with 6-year sustained virological response without significant adverse events .