Introduction Chronic hepatitis C (CHC), a mild disease in childhood, can progress to cirrhosis in young adulthood. Successful Peg-IFN+ribavirin therapy prevents progression, but has, among others, neuropsychiatric (NP) side effects (SE) that might impact on response.
Aim To study the influence of Peg-IFN+ribavirin-related NPSE on treatment response in paediatric CHC using novel age-adapted questionnaires.
Method Patients: 21 CHC children (11 boys, median age 12 yrs) treated with Peg-IFN2a+Ribavirin were divided in responders (R) (n=13), relapsers (Rel) (n=4) and non-responders (NR) (n=4). Methods: NPSE (fatigue/low mood/irritability/depression/insomnia) were assessed at each clinic visit, irrespective of age. In 15 children aged =11 yrs, NP symptom severity was evaluated at baseline, treatment week 12 (TW12), TW24, TW48 and 6 mths post therapy, using in-house questionnaires measuring degree of fatigue and social adjustment. Fatigue questionnaire: 13 questions (scored −50 to 100/question) assessing fatigue/motivation/concentration/memory/basic cognitive function (speech/word recollection). Social adjustment questionnaire: five questions (scored 0–8/question) measuring impact of therapy on school attendance/homework/social leisure activities/private leisure activities/ability to make friends.
Results 11 patients (52%) developed NPSEs, low mood and irritability being higher in NR and Rel than R (75% and 75% vs 38%, p=0.03). Children >12 yrs developed NPSEs more often than those younger (8/11 (73%) vs 3/10 (30%), p=0.04). In 15 patients aged =11 yrs (median 13 yrs) there was no difference in severity of fatigue and social adjustment scales at baseline between R (n=9), NR (n=3) and Rel (n=3) (fatigue median score: 250, 250 and 275; median social adjustment scale: 5, 10 and 9). During therapy, fatigue severity increased similarly in all groups at TW12 (R: 625; Rel: 575; NR: 800), and tended to be higher in NR than Rel and R at TW24 and 48 (TW24: 1150 vs 700 and 725, p=0.06; TW48: 1000 vs 775 and 825, p=0.1). Six months after treatment, severity of fatigue returned to pre-treatment levels, but tended to remain higher in NR and Rel than in R (NR 400 vs Rel 325 vs R 250, p=0.09). Social adjustment scale increased in all patients during therapy, tending to be higher in Rel and NR than R at TW12 (R 15 vs Rel 20 vs NR 25, p=0.06), being higher in NR than in R and Rel at TW24 and 48 (TW24: R 20 vs Rel 30 vs NR 35, p=0.05; TW48: R 17.5 vs Rel 30 vs NR 35, p=0.04), remaining higher in NR and Rel than in R (NR 15 vs Rel 15 vs R 5, p=0.02) 6 months post therapy.
Conclusion Antiviral therapy-related NPSEs are associated with poor response in children with CHC.