Background: New direct acting-antivirals (DAA) have altered HCV treatment in recent years. The absence of authorized drugs in children along with the natural evolution of the infection in childhood, generally asymptomatic until adolescence, results in little treatment experience in the population of vertically HIC/HCV co-infected subjects. The objective of this study is to describe response to DAA treatment in this unique population.
Methods: Longitudinal observational study within The Spanish National Cohort of HIV-infected children and adolescents (CoRISpe) including vertically HIV/HCV co-infected children that had received treatment against HCV when visiting adult units. Demographic, analytical, clinical and virological parameters were collected before, and 12 weeks after finishing HCV treatment.
Results: From the 651 patients transferred to adult units, 80 were HCV co-infected. Thirty-four were excluded due to data unavailability and 46 were included in the analysis (3 of them lost to follow-up and 5 deceased). 52.2% were women, median age of 26.5 years (IQR 24-30). In total, 30 patients had received treatment, at a median age of 22 years (IQR 19.7-25). At HCV-treatment initiation, all patients were on ART, 92% virollogically-suppressed, and a median CD4 T-cell count of 646 cel/ul (IQR 551-1039), 13.3% below CD4< 500cel/ul.
Genotipically, 60.6% were G1, 22.5%-G4 and 15%-G3. At treatment initiation, 24.1% presented fibrosis (F3-F4), 17.2% F2 and 55% F0-F1. Overall, 70% were treated with DAA; SOF/LED (14 patients), EBV/GZP (2p), OBV/PTR/r (2p), OBV/DSV/PTR/r (2p) y VLP/SOF (1p), plus RBV in 23%. Nine patients received interferon-therapies; IFNpeg+RBV (7p), IFN/DCV+RBV (1p) and IFN/TPV+RBV (1p). DAA-therapies were 8-12 weeks long while IFN therapies were from 12 to 48 weeks. The SVR rate with DAA was 100%, but 88.8% when IFNpeg+RBV regimens were used. After SVR at week 12 (SVR12), 38.5% improved their fibrosis stage, 15,4% worsened and 46.2% maintained their previous stage of fibrosis.
Conclusions: In our study, new DAA treatment guidelines achieved excellent cure rates (100%) in vertically HIV/HCV co-infected patients. However, 24.1% of these patients showed advanced fibrosis (F3-F4) at treatment initiation with no improvement despite treatment in 60%. To speed up access to new DAA treatments for pediatric populations is an urgent need.