Global HCV Rates for Children Could Yield New Strategies

Jonathan Schmelzer, MPH

While the prevalence of hepatitis C virus (HCV) infections is well established for adults and high-risk groups, the disease burden in children is poorly understood.

A team of investigators from the Center for Disease Analysis Foundation in Lafayette, CO, led by Jonathan Schmelzer, MPH, conducted a comprehensive literature review of articles published between 2000-2019 to determine the historical HCV prevalence estimates in children for all 249 countries and territories across the world.

“Most studies on HCV prevalence in children focus on high-risk groups and highly endemic geographic areas,” study authors wrote. “Our analysis provides global prevalence estimates of HCV in the pediatric population.”

In recent years, direct-acting antiviral (DAAs) drugs have been approved for pediatric patients as young as 3 years, proving to be a highly effective curative therapy. However, reliable prevalence estimates for adolescents is needed to inform scale-up of treatment and national strategies.

The investigators identified published HCV prevalence estimates for children under 18 years old who are not at a high risk of HCV infection in 39 countries and territories. The team inputted the data into dynamic Markov disease-burden models to estimate viraemic HCV prevalence in 2018.

For the 25 countries and territories with complete data, the team used available information on HCV prevalence in children to build regression models to predict pediatric prevalence in an additional 65 countries and territories that had country-specific or territory-specific data about predictors only.

They then created regression models for each five-year pediatric age cohort from 0-19 years that consider several predictor variables.

The data and forecasts from the 104 countries and territories with available data was used to calculate HCV prevalence by Global Burden of Disease region, which was then applied to the remaining 145 countries and territories to generate a global estimate.

The global estimate for viraemic prevalence in the pediatric population aged 0-18 was 0.13% (95% UI, .08-.16), corresponding to 3.26 million (2.07-3.9) children with HCV in 2018. HCV prevalence increased with the age of the patients in all countries and territories.

The prevalence of HCV in adults was significantly linked with HCV prevalence in children aged 5-19 (P <.0001), and the proportion of HCV infections in patients who inject drugs was significantly associated with HCV prevalence in children aged 15-19 years old (P = .036).

“Treatment in pediatric patients requires different clinical and population health management optimization than in adults,” the authors wrote. “Because of this heterogeneity, country-specific or territory-specific and age-specific HCV prevalence estimates can help countries and territories to improve national HCV elimination strategies.”

Last year, investigators discovered that the majority of adults in the US who have a hepatitis B viral (HBV) or HCV infection are completely unaware.

An analysis of nearly 15,000 adult participants, including serologic data, showed that up to 1 half of virus-infected persons have never received a diagnosis from their physician.

According to the study, the likelihood of infection awareness increased in accordance with US citizenship, higher education, income above the poverty line, not being married, lower BMI, access to insurance, history of injection drug use (for HCV-infected participants) and an atypical level of alanine aminotransferase for non-Hispanic, HBV-infected participants.

The study, “Global prevalence of hepatitis C virus in children in 2018: a modelling study,” was published online in The Lancet Gastroenterology & Hepatology.