Interferon treatment in children with chronic hepatitis C: long-lasting remission in responders, and risk for disease progression in non-responders

Background and aim. Large interferon-based therapeutic trials are still lacking in children with hepatitis C and the long-term safety and efficacy of interferon is unknown. This study describes the outcome of hepatitis C in 43 children enrolled in an open-label interferon trial, and were followed up to 66 months after stopping treatment. Patients and methods. All patients received interferon alfa2a (5 MU/m 2) thrice weekly for 6 months; children with genotype 1b received 3 MU/m 2 thrice weekly for 6 additional months. Results. Nine children discontinued interferon for adverse events and three were not compliant to treatment. Eight (19%, intention to treat analysis), including 2/20 (10%) with genotype 1b and 6/12 (50%) with genotypes 2 or 3, were sustained responders 12 months after stopping therapy. During further follow-up (mean ± S.D.: 44.7 ± 14.6 months), response was maintained; two non-responders cleared viremia, while a young boy progressed to cirrhosis. Conclusions. Small sample size and therapy withdrawal are the major limitations in the interpretation of our results. Nevertheless, our data, suggesting that response to interferon in children with hepatitis C is genotype-related and stable, agree with the results of large studies in adults. The outcome in non-responders was variable, including persistence of viremia and mild–moderate cytolysis (most cases), progression to cirrhosis, or eventual sustained viremia clearance.