There is growing recognition of global public health challenges presented by hepatitis C virus (HCV) infection, with an estimated 500,000 deaths from HCV liver disease each year. Understanding of HCV infection in adults has grown substantially in recent years, alongside extraordinary advances in the treatment of HCV with direct acting antivirals (DAAs). However, there remain striking knowledge gaps for paediatric HCV, despite the nearly seven million children living with chronic HCV worldwide. Furthermore, children have yet to benefit from DAAs, as these drugs are not yet licensed for paediatric use.
PENTAHep’s goal is to address specific knowledge gaps in order to establish best practices for the management, care and treatment of children and adolescents living with HCV.
Our work includes a series of studies of children and young people with HIV/HCV co-infection within the EPPICC network, the largest such population described to date. Research to date indicates that a substantial proportion had progressive liver disease and with low response to standard treatment with pegIFN/RBV among the minority who had been treated. We also demonstrated that HIV/HCV co-infected children on antiretroviral therapy had slower CD4+ T cell recovery than HIV mono-infected children.
Turkova A, Giacomet V, Goetghebuer T, et al. HCV treatment in children and young adults with HIV/HCV co-infection in Europe. J Virus Erad. 2015;1(3):179-184 (pdf).
Majekodunmi AO, Thorne C, Malyuta R, et al. Hepatitis C Co-Infection and CD4+ T Cell Recovery in HIV-Infected Children Receiving Anti-Retroviral Therapy. Pediatr Infect Dis J. 2016 (link).
Thorne C, Turkova A, Indolfi G, Venturini E, Giaquinto C. Co-infection with HIV and HCV in 229 children and young adults living in Europe. Aids. 2016 (link).
PENTAHep is also working in collaboration with partners in Eastern Europe to carry out epidemiological studies of HCV mono-infection. This includes a multi-centre study of 300 children and adolescents with chronic HCV in Russia in partnership with Galina Volynets, Tamara Skvortsova and Alexander Potapov (National Scientific and Practical Center of Children’s Health, Moscow), Victoria Panfilova (Krasnoyarsk State Medical University) and Natalia Rogozina (Research Institute of Childhood Infections of the Federal Biomedical Agency, Saint-Petersburg).
A multisite prospective cohort study of chronic HCV in childhood in Ukraine is an ongoing PENTAHep initiative, in partnership with PPAI, the Shupyk National Medical Academy of Postgraduate Education, and a network of clinical sites.
We are also currently undertaking a web-based survey on children with chronic hepatitis C in follow-up across the PENTAHep consortium. This collaboration will allow us to identify future research priorities in the field of paediatric HCV, plan clinical trials on emerging treatments and apply for specific grants in this field.
PENTAHep advocates for the need to overcome the barriers to paediatric access to DAAs with a vision for an HCV-free generation of children in the near future. We participated in the European Medicines Agency Expert meeting on treatment of paediatric hepatitis C, which resulted in a new approach to paediatric registration of DAAs (Thorne et al JVE Viewpoint paper – pdf) and work with the World Health Organization on advocating for research and treatment of hepatitis in children.
Dr Giuseppe Indolfi, Paediatric and Liver Unit, Meyer Children’s University Hospital of Florence, Italy firstname.lastname@example.org
Dr Claire Thorne, UCL Great Ormond Street Institute of Child Health, University College London, UK email@example.com