Direct‐acting antiviral Therapy Is Safe and Effective in Pediatric Chronic Hepatitis C

Abstract

ABSTRACT Objectives: We assessed the efficacy of decentralized public health services and safety of direct‐acting antiviral agents (DAAs) in the treatment of pediatric chronic hepatitis C (CHC) in the Mukh‐Mantri Punjab Hepatitis C Relief Fund, a public‐health initiative for prevention and control of CHC in Punjab, India. Methods: Consecutive children with CHC [age ≥12 to <18 years; both treatment‐naïve (TN) and treatment‐experienced (TE)] were enrolled. Genotyping was not recommended for non‐cirrhotic patients and were treated with sofosbuvir (SOF)+ daclatasvir (DCV) for 12 weeks, while genotyping was recommended for patients with cirrhosis. Patients with cirrhosis and genotype (G2) were treated with SOF+DCV+ribavirin (RBV) for 12 weeks, G3 with SOF+DCV+RBV for 24 weeks and G1, 4, 5, and 6 patients were treated with SOF+ledipasvir (LDV)+RBV for 12 weeks. Treatment duration was increased to 24 weeks if RBV was not tolerated. Results: In the first 16 months (June 18, 2016–October 31, 2017), 88 children (mean age 15.8 years; 69.3.3% boys, 72.3% rural) were enrolled. The mean baseline hepatitis C virus RNA log 10 IU/mL was 6.0 (range 4.2–7.5 log 10 IU/mL), 65.5% with G3, and 2 (2.5%) with cirrhosis. Of 57 with completed treatment, sustained virological response (SVR) 12 was achieved in 56 (98.2%). Unsafe medical practices (55.5%), IV drug abuse (11.1%), and prior surgery (2.7%) were risk‐factors for transmission (n = 36). Comparable results were noted in G3 (SVR at 12 weeks [SVR12], 94.3%) versus non‐G3 (SVR12, 100%; P = 0.073). No serious adverse effects like anemia and decompensation were reported. Conclusions: The study demonstrates that the decentralized algorithm‐based public‐health program can ensure high efficacy (SVR12, 98.2%) and low‐cost DAA‐based treatment of pediatric patients with CHC.