RISK FACTORS AND TREATMENT OUTCOME OF CHILDREN WITH HCV INFECTION
AbstractBackground: Combination of pegylated interferon α-2a or α-2b has been considered to be the standard for treating HCV infection among children. Many new agents inhibiting HCV during various steps while replicating is under study around the world. This study was aimed to note the efficacy of sofosbuvir and ribavirin among children having HCV infection. Methods: This was an open label experimental trail done at Department of Gastroenterology, Children Hospital and The Institute of Child Health, Multan. The study duration was from July to December 2019. A total of 89 HCV treatment naïve children aged 6–16 years of age, having HCV PCR as positive were enrolled. Sofosbuvir as 400 mg once a day along with ribavirin 10–15 mg per kg per day in the form of once or twice as divided doses were given in all the cases. After starting the treatment, along with side effects, rapid virological response (RVR) as PCR at 4 weeks, early virological response (EVR) at 12 weeks and post treatment 12 weeks HCV PCR as sustained virological response (SVR) was noted. Results: Out of a total of 89 children, there were 53 (59.6%) boys and 36 (40.4%) girls. Mean age was noted to be 12.42±2.57 years. Majority of the children, 72 (80.9%) had genotype 3 while genotype 1 was noted in 11 (12.4%) and un-typable in remaining 6 (6.7%). History of blood or blood products transfusion was seen to be the commonest mode of HCV transmission, found in 41 (46.1%) children, perinatal transmission in 20 (22.5%) and history of previous surgery in 9 (10.1%). rapid virological response was noted in 73 (83.1%) children, all 89 (100%) children achieved EVR whereas SVR was noted in 86 (96.7%). Headache was the commonest side effect, reported by 24 (27.0%) followed by nausea in 15 (16.9%). Conclusion: Regardless of the genotype, sofosbuvir and ribavirin combination therapy was noted to have excellent efficacy amongst children with HCV infection. History of blood and blood product transfusion was the commonest risk factor found.
Khaderi S, Shepherd R, Goss JA, Leung DH. Hepatitis C in the pediatric population: transmission, natural history, treatment and liver transplantation. World J Gastroenterol 2014;20(32):11281–6.
Brownell J, Polyak SJ. Molecular pathways: hepatitis C virus, CXCL10, and the inflammatory road to liver cancer. Clin Cancer Res 2013;19(6):1347–52.
El-Sayed MH, Razavi H. P1263: Global estimate of HCV infection in the pediatric and adolescent population. J Hepatol 2015;62:831–2.
Jhaveri R, Grant W, Kauf TL, McHutchison J. The burden of hepatitis C virus infection in children: estimated direct medical costs over a 10-year period. J Pediatr 2006;148(3):353–8.
Karnsakul W, Schwarz KB. Hepatitis B and C. Pediatr Clin North Am 2017;64:641–58.
Islam MS, Miah MR, Roy PK, Rahman O, Siddique AB, Chowdhury J, et al. Genotypes of hepatitis C virus infection in Bangladeshi population. Mymensingh Med J 2015;24(1):143–51.
Tahir A, Malik FR, Ahmad I, Krishin J, Akhtar P. Aetiological factors of chronic liver disease in children. J Ayub Med CollAbottabad 2011;23(2):12–4.
Luban NL, Colvin CA, Mohan P, Alter HJ. The epidemiology of transfusion-associated hepatitis C in a children’s hospital. Transfusion 2007;47(4):615–20.
Granot E, Sokal EM. Hepatitis C Virus in Children: Deferring Treatment in Expectation of Direct-Acting Antiviral Agents. Isr Med Assoc J 2015;17(11):707–11.
Sokal EM, Bourgois A, Stéphenne X, Silveira T, Porta G, Gardovska D, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection in children and adolescents. J Hepatol 2010;52(6):827–31.
Wirth S, Pieper-Boustani H, Lang T, Ballauff A, Kullmer U, Gerner P, et al. Peginterferon alfa-2b plus ribavirin treatment in children and adolescents with chronic hepatitis C. Hepatology 2005;41(5):1013–8.
Druyts E, Thorlund K, Wu P, Kanters S, Yaya S, Cooper CL, et al. Efficacy and safety of pegylated interferon alfa-2a or alfa- 2b plus ribavirin for the treatment of chronic hepatitis C in children and adolescents: a systematic review and metaanalysis. Clin Infect Dis 2013;56(7):961–7.
Tomer Y. Hepatitis C and interferon induced thyroiditis. J Autoimmun 2010;34(3):J322–6.
De Franceschi L, Fattovich G, Turrini F, Ayi K, Brugnara C, Manzato F, et al. Hemolytic anemia induced by ribavirin therapy in patients with chronic hepatitis C virus infection: role of membrane oxidative damage. Hepatology 2000;31(4):997–1004.
Herbst DA, Reddy KR. Sofosbuvir, a nucleotide polymerase inhibitor, for the treatment of chronic hepatitis C virus infection. Expert Opin Investig Drugs 2013;22(4):527–36.
Gane EJ, Stedman CA, Hyland RH, Ding X, Svarovskaia E, Symonds WT, et al. Nucleotide polymerase inhibitor sofosbuvir plus ribavirin for hepatitis C. N Engl J Med 2013;368(1):34–44.
The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America Present HCV Guidance: Recommendations for testing, managing, and treating Hepatitis C. [Internet]. Last Updated: November 6, 2019. [cited 2020 Jan]. Available from: www.hcvguidelines.org
Hashmi MA, Cheema HA. Effectiveness and Safety of Sofosbuvir in Treatment-Näive Children with Hepatitis C Infection. J Coll Physicians Surg Pak 2017;27(7):423–6.
Indolfi G, Hierro L, Dezsofi A, Jahnel J, Debray D, Hadzic N, et al. Treatment of Chronic Hepatitis C Virus Infection in Children: A Position Paper by the Hepatology Committee of European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2018;66(3):505–15.
El-Shabrawi MH, Kamal NM. Burden of pediatric hepatitis C. World J Gastroenterol 2013;19(44):7880–8.
Wirth S, Rosenthal P, Gonzalez-Peralta RP, Jonas MM, Balistreri WF, Lin C, et al. Sofosbuvir and Ribavirin in Adolescents 12-17 years old with Hepatitis C virus Genotype 2 or 3 Infection. Hepatology 2017;66(4):1102–10.
Mack CL, Gonzalez-Peralta RP, Gupta N, Leung D, Narkewicz MR, Roberts EA, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. NASPGHAN practice guidelines: Diagnosis and management of hepatitis C infection in infants, children, and adolescents. J Pediatr Gastroenterol Nutr 2012;54(6):838–55.
Pawlowska M, Sobolewska-Pilarczyk M, Domagalski K. Hepatitis C virus infection in children in the era of directacting antiviral. World J Gastroenterol 2018;24(24):2555–66.
Aziz S, Rajper J, Noorulain W. Treatment outcome of HCV infected paediatric patients and young adults at Karachi, Pakistan. J Ayub Med Coll Abbottabad 2012;24(3-4):56–8.