Hepatitis C in Children Co‐infected With Human Immunodeficiency Virus

Abstract

The effect of HIV co-infection on HCV-related disease was clear with most studies indicating that HIV accelerates HCV progression and reduces the efficacy of the available anti-HCV therapies.

Longitudinal evolution of vertically HIV/HCV–co‐infected vs HCV–mono‐infected children

“…Among children, mother to infant is by far the most common mode of transmission of HIV/HCV co‐infection, ranging from 4% and 10% according to reports from the late 90s in Europe, before generalization of combined antiretroviral treatment (ART) . As a result, the population of vertically HIV/HCV–co‐infected patients grows up in the presence of two complex chronic infections, whose long‐term effects on chronic inflammation, immune dysfunction and liver disorders have been barely explored …”

“…However, the natural history of HCV infection shows a nonlinear progression to liver disease that can accelerate with the duration of the infection and/or ageing that leads to cirrhosis in approximately 16% of patients over a 20‐year follow‐up period . However, studies including co‐infected children and adolescents are limited and remain controversial, as histopathological data are scarce, and some studies have reported mild liver fibrosis among co‐infected children . A recent multicentre study using transient elastography has described that 14.5% of vertically HIV/HCV–co‐infected children progress to advanced fibrosis at a median age of 17 years…”

“…2 As a result, the population of vertically HIV/HCV-co-infected patients grows up in the presence of two complex chronic infections, whose long-term effects on chronic inflammation, immune dysfunction and liver disorders have been barely explored. [3][4][5][6] In adult populations, a faster progression to liver fibrosis has been described in HIV/HCV-co-infected patients in comparison with HCV-mono-infected patients. 7 The pathophysiology of this phenomenon has not been well established; severe dysfunction of the immune system, metabolic abnormalities or direct liver toxicity secondary to ART exposure are thought to be some of the underlying factors.…”

“…1 However, studies including co-infected children and adolescents are limited and remain controversial, as histopathological data are scarce, and some studies have reported mild liver fibrosis among co-infected children. 5,6,11 A recent multicentre study using transient elastography has described that 14.5% of vertically HIV/HCV-co-infected children progress to advanced fibrosis at a median age of 17 years. 11 If the natural history of the HIV/HCV co-infection in children is unclear, the available evidence on the HCV treatment efficacy among this population is even more limited.…”

Modelling CD4 T Cell Recovery in Hepatitis C and HIV Co-infected Children Receiving Antiretroviral Therapy

“…9 The incidence of spontaneous HCV clearance varies in childhood depending on virus genotype and figures from 7.5% to 25% have been quoted in the literature. 10–12 However, in the presence of HIV coinfection, the likelihood of spontaneous clearance is much reduced in children 13 as in adults. 14 …”