Background:  Little is known about the prevalence, natural history, and treatment of hepatitis C virus (HCV) infection in children vertically infected with HIV.

Methods:  Retrospective analysis of all HIV-infected children followed in a large cohort in 9 public hospitals from Madrid, Spain, in whom HCV infection was diagnosed by confirmed positive HCV antibodies (above 18 months) or polymerase chain reaction (PCR). A standarized questionnaire was filled out at the last clinical visit. Liver stiffness was measured by means of percutaneous transient elastometry in 12 children; 2 patients underwent liver biopsy.

Results:  Among 265 HIV-1-infected children followed in the cohort, 97% perinatally infected, 19 were co-infected with HCV (prevalence 7.2%, CI 95% (3.9% to 10.5%). Vertical transmission was the mode of HCV infection in 18 children. Among HCV-infected children, median age at last visit was 15.3 years (9 to 29.3). Categorization of 3 children was CDC clinical category C, and of 6 was immunologic class 3. Current median CD4 count and percentage were 751/mm³ (379 to 1092) and 29.1% (17% to 42%), respectively. Median plasma HIV RNA was <50 copies/mL (<50 to 10,000); 17 patients were on ART and 2 were untreated (1 naive and 1 interrupted); 2 received specific HCV treatment because of symptoms (immune reconstitution syndrome and acute retroviral syndrome). They recieved interferon-α + ribavirin and pegylated interferon-α-2a + ribavirin, respectively. The treatment was unsuccesful in 1 patient, who is a candidate for liver transplantation. HCV genotype was determined in 18 children, of whom 12 had genotype 1, 4 genotype 4, and 2 genotype 3. Hepatomegaly was observed in 3 children and splenomegaly in 2. No child had echographic signs of portal hipertensión; 4 children had repeated negative HCV antibodies and positive PCR despite high CD4 count with HAART. Elastometry showed mild liver fibrosis in all children, but 3, who had grade 4 fibrosis.

Conclusions:  While HCV prevalence is low in HIV-co-infected Spanish patients, it appears to be much higher than in non-HIV-infected children. Although most vertically HCV-co-infected children are entering adolescence with apparent low hepatic fibrosis by elastometry, some patients (15.7% in our series) may have histologic progression. Despite high CD4 cell count, children vertically co-infected may have false negative HCV antibodies. Liver disease in HCV/HIV-co-infected children is of great concern and warrants studies on treatment outcome.