Treatment for hepatitis C was highly effective in clearing
the virus in young people co-infected with HIV and hepatitis C through vertical infection, despite advanced fibrosis
Spanish researchers report in the Journal of Viral Hepatitis.
Children who acquire both HIV and hepatitis C at birth may
be at higher risk of liver damage due to hepatitis C than children infected with
hepatitis C alone. Direct-acting antiviral treatment for children has lagged
behind adult treatment owing to a lack of studies. Sofosbuvir/ledipasvir (Harvoni)
was approved for treatment of children and adolescents over the age of 12 years
in 2017 in the United States and European Union.
trial of sofosbuvir/ledipasvir in adolescents aged 6 to 11 years reported in
2017 that the combination was safe and highly effective and Harvoni and
sofosbuvir (Sovaldi) were approved for use in children aged 3 years and over by
the US Food and Drug Administration in September 2019 for genotypes 1, 2, 4, 5
But real-world data on treatment of hepatitis C in
adolescents and young people are lacking.
Spanish researchers reported on the outcomes of 80 children
and young people vertically infected with HIV and hepatitis C. The children
were being followed as part of a national cohort of children and adolescents with
HIV and represent around 85% of vertically co-infected children in Spain.
Although they form a small proportion of young people living with HIV (around 4%)
in the Spanish national cohort, investigators described this group as
especially hard to treat, so these findings are relevant for other settings.
A comparison of 67 of the 80 cohort members with children
and young people vertically infected with hepatitis C alone showed that by the
age of 20, co-infected cohort members were more likely to have developed advanced
fibrosis (26% vs 20%). Progression to advanced fibrosis occurred during adolescence
in both groups, emphasising the importance of access to direct-acting antiviral
treatment before adolescence (Sainz).
Of the 80 children and young people, 27 underwent treatment
with direct-acting antivirals between 2015 and 2018. Twenty-two could not be
treated due to lack of data on use of the drugs in their age group or concerns
about adherence. The remainder were either lost to follow-up or died during
The average age of those treated is an indictment of the slow
progress in research into hepatitis C treatment in children. The median age at
treatment was 23 years and 30% had F3 or F4 fibrosis, indicating advanced liver
damage. Only one in four of those treated was under the age of 21. One in five
had undergone previous unsuccessful treatment with pegylated interferon and ribavirin,
the remainder were previously untreated.
Treated cohort members also had very advanced HIV disease.
Just over one in five (22%) had CDC stage C disease – either a CD4 count below
200 or an AIDS-defining illness – at the time they were treated, and treated
cohort members had taken a median of seven antiretroviral regimens. All were on antiretroviral treatment at the time of hepatitis C treatment and 24 out of 27 had an undetectable HIV viral load.
The predominant form of direct-acting antiviral treatment was sofosbuvir/ledipasvir (70%) with the remainder treated with one of five combination regimens.
Almost all (22 out of 27) underwent 12 weeks of treatment. All were cured of
“Now that DAAS are approved and available for adolescent use,
it would be interesting treating these patients at early adolescence as it is
possible and safe,” the study authors conclude. “Treatment of patients before
the start of their sexual life would have also benefits in terms of preventing