Coinfection

IAS 2013: HIV/HCV Coinfected Children in Europe Have Poor Hepatitis C Treatment Outcomes

HIV/HCV coinfection was uncommon among children and adolescents in a large European cohort, but within this group hepatitis C treatment generally occurred late and rarely led to sustained response, researchers reported at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) this month in Kuala Lumpur.

HIV positive people with hepatitis C virus (HCV) coinfection generally experience more rapid liver disease progression and respond less well to interferon-based therapy than those with HCV alone. Coinfection among children, however, has been little studied and is not well understood.

Anna Turkova from the PENTA Foundation in Padua, Italy, and colleagues retrospectively evaluated the use and effectiveness of hepatitis C treatment for coinfected children and young people, age 25 and younger, in the Europe Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC).

The researchers identified 10 coinfected children and adolescents (4 boys and 6 girls), from 4 of the 10 included cohorts. All were infected perinatally or during early childhood. Most (80%) had HCV genotype 1, with the remaining 2 having genotype 4 and unknown genotype. The patients had been infected with HCV for a median of about 13 years, and the median age was 17 at the start of hepatitis C treatment (range 10 to 21 years).

The children had relatively advanced HIV disease in the past, with a nadir (lowest-ever) CD4 T-cell count of 194 cells/mm³, but when they started hepatitis C treatment the median level was high, at 584 cells/mm³. All were on antiretroviral therapy (ART) along with hepatitis C treatment and two-thirds had undetectable HIV RNA.

Results

• Among the 7 participants with available fibrosis staging information, 2 had Metavir stage F2 (moderate) fibrosis, 3 had stage F3 (advanced) fibrosis, and 2 had stage F4 cirrhosis.
• Half the children were treated with pegylated interferon alfa-2a (Pegasys) and half with pegylated interferon alfa-2b (PegIntron), with median doses of 180 mcg/week and 80 mcg/week, respectively.
• All also received ribavirin, with a median dose of 600 mg/day (range 200-1000 mg/day), reflecting weight-based dosing.
• The median duration of hepatitis C therapy was 48 weeks, with a range of 12 to 77 weeks.
• 1 patient with HCV genotype 1 experienced early virological response (undetectable HCV RNA at week 12 of treatment) and went on to achieve sustained virological response (SVR), or continued HCV suppression after completion of treatment.
• However, no other participants experienced more than a 2-log decrease in HCV RNA by week 12 of treatment, and none achieved SVR.
• No children discontinued treatment due to safety concerns, though 2 experienced decreased neutrophil counts (neutropenia).
• 1 patient underwent retreatment 2 years after the first course, but died 46 days after a liver transplant, at age 16.

"There is a very limited experience of treating HCV in HIV/HCV coinfected children," the researchers concluded. "Our results show poor treatment outcomes in these cases, most of whom had advanced fibrosis and genotype 1."

7/24/13

Reference

A Turkova, C Thorne, L Galli, et al. HCV treatment in children and young adults with HIV/HCV co-infection in Europe. 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013. Abstract. Abstract WEPE484.