Mogahed Engy Adel, Nabil Nevian, Ghita Haytham, Enayet Afaf, El-Karaksy Hanaa
Pediatric Hepatology Unit, Department of Pediatrics, Cairo University, Cairo, Egypt.
, 2 B Sama City, Katamya, Cairo, 11439, Egypt.
Eur J Pediatr. 2025 Mar 10;184(3):235. doi: 10.1007/s00431-025-06038-3.
Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment and enabled the treatment of those who could not be treated using interferon. The aim of this work was to assess the efficacy and safety of oral DAAs in HCV-infected children with associated comorbidities. This analytical retrospective study included children with HCV mono-infection versus those with associated comorbidities. The study included 187 HCV-infected children aged 6-18 years; 114 patients (61%) had associated comorbidities. The most frequent comorbidities were hematological disorders (30.7%), followed by renal and cardiac diseases. Baseline total bilirubin, aspartate aminotransferase, and gamma glutamyl transpeptidase were significantly more elevated in patients with comorbidities. Sustained virologic response (SVR) was achieved in 100% of patients with HCV mono-infection versus 98.2% of patients with comorbidities. The most frequently reported treatment adverse effects were headache, asthenia, and irritability. All side effects were transient and did not necessitate treatment discontinuation.
DAAs allowed treatment of HCV-infected children with comorbidities with high SVR and excellent safety profile. Treatment with sofosbuvir/ledipasvir achieved an SVR of 98.9% in HCV-infected children with comorbidities. Treatment was safe and well tolerated with mild transient adverse events.
• The novel DAAs have revolutionized the landscape of HCV treatment and enabled the treatment of those who could not be treated using IFN. • When treating HCV, clinicians should take into consideration the presence of other comorbid conditions. In the IFN-RBV era, many HCV patients with comorbidities were ineligible for therapy.
• There are limited data in the literature about the efficacy and tolerability of DAAs in children with comorbidities. • We reported in the current study that DAAs allowed treatment of HCV-infected children with comorbidities with high SVR and excellent safety profile. These patients should be offered treatment with oral DAAs to help decrease the infectious pool and hence reach the ambitious final goal of global eradication.
直接作用抗病毒药物（DAAs）彻底改变了丙型肝炎病毒（HCV）的治疗方式，并使那些无法使用干扰素治疗的患者能够接受治疗。这项研究的目的是评估口服DAAs在合并其他疾病的HCV感染儿童中的疗效和安全性。这项分析性回顾研究纳入了HCV单一感染儿童与合并其他疾病的儿童。该研究纳入了187名6至18岁的HCV感染儿童；114名患者（61%）合并其他疾病。最常见的合并症是血液系统疾病（30.7%），其次是肾脏和心脏疾病。合并症患者的基线总胆红素、天冬氨酸转氨酶和γ-谷氨酰转肽酶水平显著更高。HCV单一感染患者的持续病毒学应答（SVR）率为100%，而合并症患者为98.2%。最常报告的治疗不良反应是头痛、乏力和易怒。所有副作用都是短暂的，无需停药。
DAAs能够治疗合并其他疾病的HCV感染儿童，SVR率高且安全性良好。索磷布韦/维帕他韦治疗合并其他疾病的HCV感染儿童的SVR率为98.9%。治疗安全且耐受性良好，不良事件轻微且短暂。
•新型DAAs彻底改变了HCV治疗格局，使那些无法使用干扰素治疗的患者能够接受治疗。•治疗HCV时，临床医生应考虑是否存在其他合并症。在干扰素-利巴韦林时代，许多合并其他疾病的HCV患者不符合治疗条件。
•关于DAAs在合并其他疾病儿童中的疗效和耐受性，文献数据有限。•我们在本研究中报告，DAAs能够治疗合并其他疾病的HCV感染儿童，SVR率高且安全性良好。应给予这些患者口服DAAs治疗，以帮助减少传染源，从而实现全球根除这一宏伟的最终目标。
