Hepatitis C Virus in Thalassemia

Prevalence of hepatitis C virus (HCV) infection is relatively low in children. However, seroprevalence rates of 10–20% have been reported among children who received repeated transfusion. The development and the severity of liver fibrosis are strongly related to the extent of the liver iron overload and to the presence of chronic hepatitis C (CHC). In CHC, liver iron overload has been suggested as a negative prognos- tic factor exacerbating inflammation with subsequent progression of liver fibrosis and decrease in antiviral therapy effectiveness. CHC may be suspected based on medical history or accidentally discovered abnormal liver functions. Hepatitis C is diagnosed by positive serology for viral antibodies and confirmed by polymerase chain reaction (PCR) to detect virus RNA. The treatment of HCV infection in children was difficult due to the limitations of pegylated interferon-α and ribavirin. In 2017, FDA approved the first direct-acting antiviral agents (DAAs) for children including ledipasvir/sofosbuvir in the adult dose, 90/400 mg, to treat HCV in children and adolescents aged 12 years and older or weighing at least 35 kg. Similarly, giving half the adult fixed-dose of ledipas -vir/sofosbuvir, 45/200 mg, to children aged 6–11 years is still under clinical trials with promising results.