Act Now! Treating HCV in Children is Safe and Effective

There are 3.5 million children around the world living with chronic hepatitis C. In Australia, the prevalence is estimated to be at least 0.4 cases per 100 000 children under the age of 15 years. Chronic hepatitis C in children can often move very slowly, but it may still progress to hepatic fibrosis, chronic liver disease, and hepatocellular cancer. These often marginalised children experience reduced quality of life, social stigmatisation, and inadequate access to specialist care. Research led by Jessica Eldredge and published in the Medical Journal of Australia argues that early treatment of HCV in children is cost-effective and reduces the lifetime impact of chronic liver disease and its side-effects. The study, Direct-acting antiviral treatments in Australia for children with chronic hepatitis C virus infection, was published in January.

Australia-wide, direct-acting antiviral (DAA) treatments have revolutionised the management of HCV infection since they were made available on the Pharmaceutical Benefits Scheme in 2016. In 2020 age restrictions for several DAAs were removed.

Dr Eldredge’s team examined outcomes for children under 18 years of age with HCV infection treated with DAAs in the four years between April 2018 and April 2022 at five tertiary children’s hospitals across three Australian states. Fifty-four children with HCV infection commenced DAA treatment at the five participating hospitals during the study period, using four different DAA combinations. Nine of these patients were Aboriginal or Torres Strait Islander people. None of the children had received previous treatments for HCV infection. None had documented cirrhosis, but liver biopsy identified early fibrosis in one child. Four of the children had foetal alcohol spectrum disorder. Perinatal viral transmission was suspected in 51 of the cases, while injecting drug use was known to be the source of infection in the other three.

Over the course of the study, two children could not be followed up, and one did not complete treatment because of difficulty swallowing the DAA tablet. Fifty of the fifty-one children who completed treatment and were followed up had no detectable HCV in their bodies 12 weeks after treatment, and, like the child who did not complete the treatment, the fifty-first had also had trouble swallowing the tablets, leading to erratic adherance.

The DAA treatments were well tolerated, and the results show that they were highly effective at treating HCV infections in children, which is consistent with their efficacy in children and adolescents in clinical trials worldwide. Adherence to therapy was shown to be important when treating younger children; making use of smaller tablets or powdered medication was also shown to be of use for those children who have trouble swallowing standard-sized pills, and improved treatment efficacy for them as well.

The World Health Organization has set the ambitious target of eradicating HCV globally by 2030. It has recently been projected that only 72% of Australians (all ages) with chronic HCV infection will be treated by that year. Screening infants and children at particular risk should be the priority, with a focus on early referral to tertiary specialists with experience in treating HCV infection in children. Treating infected Australians early in life will minimise the risk of them being lost to medical follow-up, as well as reducing liver-related morbidity, social stigmatisation, and the risks of vertical and horizontal viral transmission.

READ MORE:

onlinelibrary.wiley.com/doi/full/10.5694/mja2.51852

hepcguidelines.org.au/wp-content/uploads/2021/11/HCV_in_Children_Guidance_Final_Nov2021.pdf

onlinelibrary.wiley.com/doi/10.1111/ jpc.12904