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The challenge of treating hepatitis C virus infection in children with comorbidities

Engy Adel Mogahed1,2, Nevian Nabil3, Haytham Ghita3

  • 1Pediatric Hepatology Unit, Department of Pediatrics, Cairo University, Cairo, Egypt. engy.mogahed@kasralainy.edu.eg.

European Journal of Pediatrics
|March 10, 2025
PubMed

Insights

Direct-acting antivirals (DAAs) offer a safe and effective treatment for children with hepatitis C virus (HCV) infection, even those with comorbidities. These treatments achieve high sustained virologic response rates with minimal, transient side effects.

Area of Science:

  • Hepatology
  • Pediatric Infectious Diseases
  • Pharmacology

Background:

  • Direct-acting antivirals (DAAs) have transformed hepatitis C virus (HCV) treatment, expanding options for patients previously ineligible for interferon-based therapies.
  • Limited data exist on the efficacy and safety of DAAs in pediatric populations, particularly those with co-existing medical conditions.

Purpose of the Study:

  • To evaluate the efficacy and safety of oral DAAs in children aged 6-18 years diagnosed with HCV.
  • To compare treatment outcomes in children with HCV mono-infection versus those with associated comorbidities.

Main Methods:

  • An analytical retrospective study involving 187 children with HCV infection.
  • Categorization of patients into HCV mono-infection and HCV with comorbidities groups.
  • Assessment of baseline clinical parameters, sustained virologic response (SVR), and treatment-emergent adverse events.

Main Results:

  • 114 patients (61%) presented with comorbidities, most commonly hematological, renal, and cardiac disorders.
  • Significantly elevated baseline liver enzymes and bilirubin were observed in patients with comorbidities.
  • Sustained virologic response (SVR) rates were high: 100% in mono-infected children and 98.2% in those with comorbidities.
  • The most frequent adverse events (headache, asthenia, irritability) were mild and transient, not requiring treatment cessation.

Conclusions:

  • Oral DAAs are highly effective and safe for treating HCV in children, including those with comorbidities, achieving excellent SVR rates.
  • Sofosbuvir/ledipasvir demonstrated a 98.9% SVR in pediatric patients with comorbidities.
  • DAA treatment is well-tolerated in children, with manageable and temporary side effects, supporting its role in reducing the HCV infectious pool.

Keywords:
ChildrenComorbiditiesDAAsDirect-acting antiviralsEfficacyHCVSVRSafetySustained virologic response

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