Coinfection with HIV and hepatitis C virus in 229 children and young adults living in Europe. AIDS
Thorne et al. on behalf of EuroCoord aimed to conduct a study of HIV/hepatitis C virus (HCV) coinfection in children, adolescents and young adults infected with HIV/HCV vertically or before age 18 years to characterize this subpopulation with respect to mode of acquisition, HCV genotype, clinical status and treatment.
Of 229 patients included, 62% had vertically acquired infection. Median age at last follow-up was 16.2 years. Most children had HCV genotype 1 (55%) or 3 (31%). One-fifth had a previous AIDS diagnosis. At their last clinic visit, 70% had no/mild immunosuppression (CDC stage 1), and 73% on antiretroviral therapy had undetectable HIV RNA. Overall, 55% had alanine aminotransferase levels of more than 40 IU/l at their last test. Of 97 patients with transient elastography, 12 had results of more than 9 kPa; this was associated with duration of HCV infection (P=0.033), but not with CD4+ cell count, antiretroviral therapy use or sex in univariable analysis. Of 17 patients with liver biopsies, six had bridging fibrosis and one had cirrhosis. The SVR24 rates among the individuals treated with pegylated interferon and ribavirin were 32% (8/25) for genotype 1 and 79% (15/19) for genotype 3; the one treated patient with genotype 2 achieved an SVR24, but none of the three treated patients with genotype 4 did so.
In conclusion, the current study is the first one describing a large population of HIV/HCV coinfected children and young people across Europe. As clinical management of coinfected children has previously relied on extrapolation from adult studies, the findings will contribute to better understanding of this coinfection in childhood. The study describes a substantial proportion of HIV/HCV coinfected children and young people with progressive liver disease, with low response to standard treatment with pegIFN/RBV among the minority treated to date.
Considering this, the improved life expectancy in HIV-infected children and the excellent outcomes in adults with HIV/HCV infection treated with direct acting agents, illustrate the need for these HCV treatments in HIV/HCV coinfected children.