Clinical scenario: Hep C +ve | no CLD| mild fibrosis | treatment
A 16-year-old boy is referred for evaluation of persistently abnormal liver function tests. He received multiple blood transfusions during infancy for aplastic anemia. He is asymptomatic. Examination is unremarkable with no stigmata of chronic liver disease.
Investigations reveal:
- ALT: 186 U/L (normal <40 U/L)
- AST: 142 U/L
- Total bilirubin: 0.8 mg/dL
- Albumin: 4.3 g/dL
- INR: 1.0
- HBsAg: Negative
- Anti-HCV antibody: Positive
- HCV RNA (PCR): Positive, 2.4 × 10⁶ IU/mL
- Transient elastography: Mild fibrosis (F1)
Which of the following is the most appropriate treatment?
A. Interferon alfa plus ribavirin for 48 weeks
B. Entecavir
C. Sofosbuvir/velpatasvir
D. Prednisolone
E. Observe without treatment because fibrosis is minimal
Correct answer & Explanation:
Correct answer: C. Sofosbuvir/velpatasvir
Explanation: Chronic hepatitis C Treatment
This adolescent has chronic hepatitis C infection, confirmed by positive HCV RNA. Current pediatric guidelines recommend that all children aged ≥3 years with chronic hepatitis C should receive direct-acting antiviral (DAA) therapy, irrespective of ALT level or fibrosis stage, unless there is a specific contraindication.
Sofosbuvir/velpatasvir is a pangenotypic DAA regimen approved for children aged 3 years and older and achieves sustained virologic response (SVR) rates exceeding 95% across all HCV genotypes. Early treatment prevents progression to cirrhosis, hepatocellular carcinoma, and ongoing viral transmission.
Why the other options are incorrect
A. Interferon alfa plus ribavirin
- Previously the standard of care but has been replaced by DAAs because of lower efficacy, longer treatment duration, and significant adverse effects.
B. Entecavir
- Active against hepatitis B virus, not hepatitis C.
D. Prednisolone
- Has no role in chronic hepatitis C and may increase viral replication.
E. Observe without treatment
- Current recommendations advise treating all eligible children with chronic HCV infection, even in the presence of minimal fibrosis.
High-yield pearl
Confirmation of chronic hepatitis C requires detection of HCV RNA, not anti-HCV antibody alone. Once chronic infection is confirmed in a child ≥3 years of age, direct-acting antiviral therapy is recommended regardless of disease severity, with cure rates exceeding 95% after a standard treatment course.
