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HCV in Young Adults and Children: 3 Studies At-a-Glance
Andrew D. Bowser
Study summaries highlight increased infection rates in young adults; a spike in HCV in reproductive-aged women; and a potential new treatment for HCV in young children.
The demographics of hepatitis-C virus (HCV) infection are skewing younger recently, in large part due to the epidemic of injection drug use. Click through the slides above for a briefing on 3 important new studies:
- A state-level data analysis documenting concerning rises in HCV rates/seroprevalence in younger adults; results make a strong case for universal screening for all adults
- A study showing a doubling of HCV infection rates in reproductive-aged women in less than a decade, as well as a recent spike in infection rates among young children
- An open-label study showing high rates of sustained virologic response and a favorable safety profile in children younger than 12 years of age
As HCV Demographics Shift, Screen All Adults? Despite a major shift in epidemiology to teenagers and young adults, universal screening is recommended only in Baby Boomers. Morse and colleagues hypothesized that HCV cases/rates for young adults would be comparable to that of Baby Boomers, which could justify universal screening for all adults.
Young Adults HCV Cases/Rates At/Above Boomer Levels. For 26 of 28 states with sufficient data, investigators found that the reported HCV cases or seroprevalence rates were higher in young adults, equal between young adults and Baby Boomers, or lower in young adults but with sustained increases. Based on these data, they said universal screening could help increase the number of HCV-infected young adults identified.
They suggested it would be logical to start universal screening during pregnancy, given a high HCV prevalence seen in this cohort. That observation leads us to the next study, which looked at rates of HCV infection in reproductive-aged women and children in the US.
HCV Infection in Women of Childbearing Age, Unknown. Ly and colleagues sought to develop an estimate of HCV infection among US reproductive-aged women and their offspring based on data from the National Notifiable Diseases Surveillance System and the Quest Diagnostics Health Trends national database.
Significant Increase in HCV Infection Rates. These data suggest HCV infection is on the rise among reproductive-age women, a finding the authors point to as relevant to deliberations regarding the potential role of routine HCV screening during pregnancy, which is now recommended in HCV guidelines.
Poor HCV Treatment Options for Children. There is an unmet need for direct acting antiviral (DAA) treatment of children younger than 12 years. Children treated with the currently available option, interferon-based therapy, experience poor results tolerability and potential impacts on growth and development, according to investigators in this study.
Treatment According to HCV Genotype, Cirrhosis Status. Murray and colleagues conducted an open-label study of ledipasvir-sofosbuvir as 2 fixed-dose combinations tablets once daily, +/- ribavirin, for 12 or 24 weeks according to HCV genotype and cirrhosis status. Authors enrolled 92 patients with a median age of 9 years.
Ledipasvir-sofosbuvir Safe, Effective for HIV-infected Children. This study suggests the treatment is highly effective and safe in children 6 to <12 years old with chronic HCV. “Given the poor tolerability and the well-documented side effects of pegylated interferon, expanding treatment options for children 6 to <12 years old with chronic HCV infection to include an all oral, DAA regimen would represent an important advancement in care in this patient population,” Karen F. Murray and co-investigators said in their report on the study.
References:
1. Morse A, Barritt AS 4th, Jhaveri R. Individual state hepatitis C data support expanding screening beyond baby boomers to all adults. Gastroenterology. 2018;154:1850-1851.
2. Ly KN, Jiles RB, Teshale EH, et al. Hepatitis C virus infection among reproductive–age women and children in the United States, 2006 to 2014. Ann Intern Med. 2017;166:775-782.
3. Murray KF, Balistreri WF, Bansal S, et al. Safety and efficacy of ledipasvir/sofosbuvir with or without ribavarin for chronic hepatitis C in children ages 6-11. Hepatology. 2018.