HIV/HCV Co-Infected Children May Significantly Benefit From Early DAA Treatment

Children who are co-infected with HIV and hepatitis C virus (HCV) may benefit from early treatment with direct acting antiviral (DAA) agents, according to study results published in the Journal of Viral Hepatitis

It is estimated that roughly 20% to 30% of the 37 million people living with HIV globally are co-infected with chronic HCV. This co-infection phenomenon can be explained by the fact that both viruses share transmission routes. Mother to infant is the most common mode of transmission in infants who are co-infected and long-term effects of liver disorders, chronic inflammation, and immune dysfunction are not well explored. The standard HCV treatment had been pegylated interferon plus ribavirin (Peg-IFN/RBV); however, it has been replaced with DAAs, but data supporting this treatment in co-infected children and adolescents is lacking. Therefore, this retrospective multicenter study aimed to describe the longitudinal evolution of vertically acquired HIV/HCV co-infection in youths compared with HCV infection alone.

Patients who were co-infected with HIV/HCV in whom longitudinal follow-up was available were included in the study and were compared with a random sample of vertically HCV mono-infected patients from a National Paediatric Hepatology Reference Center in Spain and were matched for sex and age. Data was analyzed according to the World Health Organization categories, as follows: children, aged £11 years; adolescents, aged 12 to 17 years; and adults, aged ³18 years. Liver fibrosis was defined according to transient elastography as follows: METAVIR score F0-1 for no or mild fibrosis, F2 for moderate fibrosis, F3 for advanced fibrosis, and F4 for cirrhosis. A successful outcome was defined as sustained virologic response 24 weeks after the end of DAA therapy. Virologic suppression of HIV was achieved if there were >50 copies/mL of HIV RNA. Time to progression was calculated from birth to first record of fibrosis progression.

The results showed that compared with children who had HCV mono-infection, children with HIV/HCV co-infection did not have an accelerated progression to liver fibrosis during childhood and during the first decade, no progression to advanced liver disease was observed. In adulthood, at a median age of 20 years, 9 of 35 patients had advanced fibrosis with no differences between the mono- and co-infected groups (P =1.00). Between the mono- and co-infected groups, progression to F3 was comparable (P =.430). In the patients who progressed, the median time to progression was 13.6 years in the mono-infected group and 18.7 years in the co-infected group (P =.239).

There were significant differences between the groups in terms of HCV treatment. Compared with the co-infected group, more children in the mono-infected group received treatment during the study period (P <.001); in addition, they initiated treatment at a younger age (P <.001). All treated patients received regimens based on Peg-IFN/RBV. The response to Peg-IFN/RBV was poor and comparable in both groups, which highlights a need for fast access to early treatment with DAAs in patients with co-infection. Further, there was no association between HIV co-infection and treatment non-response (P =.967; however, the IL28L-CT polymorphism was significantly associated with treatment non-response (P =.029).

Overall, the study authors concluded that, “Our data support the fact that HIV/[HCV] co-infected children patients might benefit from early HCV treatment, as soon as direct antivirals are available for children.”

Reference

Sainz T, McPhee CF, Dominguez-Rodriguez S, et al. Longitudinal evolution of vertically HIV/HCV coinfected vs HCV monoinfected children [published online September 13, 2019]. doi:10.1111/jvh.13206