Pediatric perspectives on treating uncommon genotypes of hepatitis C in the United States

Abstract

Rationale: Hepatitis C in the pediatric population is a large health burden globally. With its diverse genotypes as well as genotypic subtypes, there is a discrepancy in the genotypes used in research compared to their prevalence. HCV genotype 6 which is endemic to South China and Southeast Asia comprises approximately one-third of all HCV infections worldwide, but make up a minority of cases studied in HCV research. Patient concerns: We report a case of HCV-6 seen in an 11-year-old Burmese immigrant to the U.S. and describe the new direct acting antiviral treatment guidelines for pediatrics with HCV genotype 6. Interventions: The patient completed a 12-week course of ledipasvir/sofosbuvir (90 mg/400 mg), per FDA weight-based recommendations for treatment-naive HCV genotypes 4-6, without any complications. Outcomes: The patient was treated successfully with an undetectable HCV viral load one month after treatment completion. Lessons: HCV-6, although previously uncommon in the U.S., is becoming more prevalent. Updated guidelines include the use of direct acting antivirals, which have been proven effective for HCV-6. Lessons on barriers to care in the immigrant population as well as the value of HCV genotyping are also discussed.