Curtis Megan Rose, Munroe Sarah, Biondi Breanne E, Ciaranello Andrea L, Linas Benjamin P, Epstein Rachel L
Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts.
Pediatrics. 2025 May 1;155(5). doi: 10.1542/peds.2024-068565.
Pediatric HCV cases have increased in the United States. Guidelines recommend beginning treatment of HCV for children as young as 3 years old. However, no studies have evaluated pediatric linkage to HCV care and direct-acting antiviral (DAA) uptake on a national level. This study aims to characterize the HCV care cascade among a national cohort of children with HCV.
This retrospective cohort analysis included children born between 2000 and 2018 who were diagnosed with HCV between the ages of 0 and 18 years. We analyzed TriNetX Research Network data, a US national electronic health records network. Primary HCV care cascade outcomes included the number of children diagnosed with HCV infection, linked to care, and prescribed DAAs. We assessed the association between race and ethnicity with linkage to care using logistic regression.
Among 928 children with HCV, 297 (32.0%) linked to HCV care and 111 (12.0%) were prescribed a DAA. Hispanic/Latinx children had double and white children had triple the odds of linkage compared with Black children (odds ratio [OR], 2.20; 95% CI, 1.05-4.59; OR, 3.44; 95% CI, 1.89-6.28) after adjusting for sex, birth cohort, and region.
Pediatric access to HCV care remains low. Fewer than 1 in 3 children linked to HCV care and fewer than 1 in 8 were treated. This study uncovers racial and ethnic disparities in HCV care access. Targeting interventions toward increasing linkage to care could represent an opportunity to advance HCV elimination goals and reduce disparities.
美国儿童丙型肝炎病毒（HCV）病例有所增加。指南建议对年仅3岁的儿童开始HCV治疗。然而，尚无研究在国家层面评估儿童与HCV治疗的衔接情况以及直接抗病毒药物（DAA）的使用情况。本研究旨在描述全国HCV感染儿童队列中的HCV治疗流程。
这项回顾性队列分析纳入了2000年至2018年出生、0至18岁期间被诊断为HCV的儿童。我们分析了美国国家电子健康记录网络TriNetX研究网络的数据。主要的HCV治疗流程结果包括被诊断为HCV感染、接受治疗以及开具DAA处方的儿童数量。我们使用逻辑回归评估种族与接受治疗之间的关联。
在928例HCV感染儿童中，297例（32.0%）接受了HCV治疗，111例（12.0%）开具了DAA处方。在调整性别、出生队列和地区后，西班牙裔/拉丁裔儿童接受治疗的几率是黑人儿童的两倍，白人儿童是黑人儿童的三倍（优势比[OR]，2.20；95%置信区间[CI]，1.05 - 4.59；OR，3.44；95% CI，1.89 - 6.28）。
儿童获得HCV治疗的机会仍然很低。每3名HCV感染儿童中接受治疗的不到1名，每8名中接受治疗的不到1名。本研究揭示了HCV治疗可及性方面的种族和民族差异。针对提高治疗衔接率的干预措施可能是推进HCV消除目标和减少差异的一个契机。
