- Title
- Direct-acting antiviral treatments in Australia for children with chronic hepatitis C virus infection
- Creator
- Eldredge, Jessica A.; Stormon, Michael O.; Clark, Julia E.; Nightingale, Scott; McMullan, Brendan; Andersen, Brooke; Travers, Christina; Hardikar, Winita
- Relation
- Medical Journal of Australia Vol. 218, Issue 5, p. 229-230
- Publisher Link
- http://dx.doi.org/10.5694/mja2.51852
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2023
- Description
- Three and one-half million children around the world have chronic hepatitis C virus (HCV) infection.1 In Australia, the prevalence is estimated to be at least 0.4 cases per 100 000 children under 15 years of age.2 Chronic hepatitis C in children can have an indolent course, but can 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 in Australia.3, 4 Early treatment of HCV in children is cost-effective and reduces the lifetime impact of chronic liver disease and its sequelae.5 Direct-acting antiviral (DAA) treatments have revolutionised the management of HCV infection. In April 2020, age restrictions were removed for three fixed dose DAA preparations subsidised in Australia by the Pharmaceutical Benefits Scheme (PBS).4 We examined outcomes for children under 18 years of age with HCV infection treated with DAAs during 1 April 2018 – 1 April 2022 at five tertiary children's hospitals (Royal Children's Hospital, Victoria; Children's Hospital at Westmead, Sydney Children's Hospital Randwick, and John Hunter Children's Hospital, New South Wales; and the Queensland Children's Hospital). Cases were identified by retrospective medical record review of all children treated for hepatitis C during the study period. Sustained viral response was defined as HCV RNA not being detectable by polymerase chain reaction twelve weeks or more after treatment completion (SVR12). Our study was approved by the human research ethics committee of the Royal Children's Hospital, Melbourne (HREC/75391/RCHM-2021). Fifty-four children with HCV infection commenced DAA treatment at the five participating hospitals during the study period: 32 received glecaprevir/pibrentasvir, eleven ledipasvir/sofosbuvir, ten sofosbuvir/velpatasvir, and one child received sofosbuvir and ribavirin. Eight children commenced DAA treatment prior to April 2020 (with local institutional drug committee approval, compassionate access, or clinical trial participation), 46 after age restrictions were removed in April 2020. None of the children had received previous treatments for HCV infection. None had documented cirrhosis based on clinical, biochemical, or biopsy assessment by their treating specialists, but liver biopsy identified early fibrosis in one child (carrier of the genetic mutation for alpha-1 antitrypsin deficiency). Four children had foetal alcohol spectrum disorder, and nine patients were Aboriginal or Torres Strait Islander people. Perinatal viral transmission was suspected in 51 cases (Box). Box 1. Demographic and baseline biochemistry characteristics of 54 children under 18 years of age who commenced direct-acting antiviral treatment for chronic hepatitis C virus (HCV) infections at five Australian children's hospitals, 1 April 2018 – 1 April 2022.
- Subject
- hepatitis c; hepatitis; viral; pediatrics; gastrointestinal diseases; public health; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1488103
- Identifier
- uon:52348
- Identifier
- ISSN:0025-729X
- Language
- eng
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