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Fewer than 1 in 3 children with hepatitis C (HCV) see a clinician for care, and fewer than 1 in 8 receive treatment.

HCV cases in children are rising, yet access to treatment is limited, especially for Black children, according to a new retrospective cohort analysis published in Pediatrics. Treatment entails direct-acting antiviral agents, for which 95% of patients have no detectable trace of the virus 12 weeks after treatment.

“HCV is a silent killer,” said Megan Rose Curtis, MD, MS, the lead author of the study. “It can be asymptomatic for many years until the third decade of life if a child is infected perinatally” and does not receive treatment.

The prevalence of HCV in pregnant people jumped 16-fold between 1998 and 2018 to 5.3 cases per every 1000 pregnancies, and these patients can transmit the disease perinatally. Many people are unaware they are infected.

Curtis and her team analyzed electronic medical records of children diagnosed with HCV born over an 18-year period starting in 2000 using the TriNetX Research Network. They also included data on prescriptions for direct-acting antivirals, appointments with healthcare providers, and race and ethnicity.

The sample included 928 children with HCV (52.3% women; 55.9% White) and excluded children whose HCV had spontaneously cleared.

A little over one third (32%) of children had seen a clinician for HCV care, which was defined as having in their record an antiviral prescription, a fibrosis stage, an order for an HCV genotype test, or a diagnosis of the disease.

Even fewer children (12%) were prescribed an antiviral.

Children with certain characteristics were more likely to receive care, the researchers found. For instance, children born between 2014 and 2018 (P = .008) and those diagnosed at age 0-3 years (P = .03) were most likely to see a clinician and receive treatment.

The current recommended treatment regimen for pediatric HCV — glecaprevir/pibrentasvir (Mavyret) or sofosbuvir/velpatasvir (Epclusa) — became available in 2017.

Hispanic/Latinx and White children were 120% and 240% more likely than Black children, respectively, to have received care (odds ratio [OR], 2.20; 95% CI, 1.05-4.59 and OR, 3.44; 95% CI, 1.89-6.28). Children living in southern states were less likely to have seen a doctor for HCV treatment.

Curtis said children might not receive treatment because their caregivers do not bring them to follow-up appointments, possibly because they struggle with stable housing or transportation. Insurance companies also sometimes will not pay for the treatment.

“If you have a golden opportunity to see someone in your office, it might be the only chance someone offers them HCV treatment. It can have a huge and transformative impact on someone’s life,” she said.

Jenelle Ferry, MD, a neonatologist at Pediatrix Medical Group in Tampa, Florida, said clinicians should routinely screen children and refer caregivers to a pediatric hepatologist for further management.

Pediatricians who suspect HCV in their patients should order a test for viral nucleic acid or viral load or request a polymerase chain reaction test.

Curtis noted that more than half of children clear the infection on their own by age 3, the age at which treatment can also begin. Treatment may also not be the right option for those who cannot swallow the medicine, which is available in oral pellets for children.

Greg Marchand, MD, an OB/GYN at the Marchand Institute for Minimally Invasive Surgery in Mesa, Arizona, said the research illuminates a “huge missed opportunity” to help children.

“If left untreated, these children risk serious liver complications like cirrhosis, liver cancer, high medical costs, and even death,” he said.

Marchand said clinicians must be aware of the guidelines for testing people who are pregnant and infants. In 2020, the US Centers for Disease Control and Prevention recommended universal HCV antibody screening during every pregnancy.

“There’s still hope that treatment rates will improve as both doctors and families become more familiar with” the newer drugs, he said.

No financial disclosures were reported.

The authors of this study were supported by various grants and awards, including from the National Institutes of Health, the James and Audrey Foster MGH Research Scholar Award, the Charles A. King Trust Postdoctoral Research Fellowship, and the Boston University Clinical and Translational Science Institute.

Lisa Marie Basile is a freelance journalist.