Co esponding au ho : Halde J Abozai and Naw al R Hussein
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Success ul So osbu i /Velpa as i e ea men in wo pedia ic oncology pa ien s
wi h ch onic hepa i is C a e ini ial DAA ailu e: A case epo
Aya R Hussein 1, Halde J Abozai 2, * and Naw al R Hussein 3, *
1 Ba zan P ima y heal hca e cen e , Duhok, Ku dis an Region, I aq.
2 Depa men o Medicine, College o Medicine, Uni e si y o Duhok, Duhok, Ku dis an Region, I aq.
3 Depa men o biomedical sciences, College o Medicine, Uni e si y o Zakho, Zakho independen adminis a ion,
Ku dis an Region, I aq.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 775-778
Publica ion his o y: Recei ed on 26 Ma ch 2025; e ised on 03 May 2025; accep ed on 06 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1733
Abs ac
Hepa i is C i us (HCV) in ec ion emains a signi ican conce n o pedia ic oncology pa ien s who equi e mul iple
blood ans usions. Al hough di ec -ac ing an i i al (DAA) he apies ha e e olu ionized HCV ea men , ecu ence
a e ini ial ea men can occu . We epo wo pedia ic oncology pa ien s who expe ienced HCV elapse a e s anda d
DAA egimens bu esponded success ully o e ea men wi h so osbu i / elpa as i . Pa ien 1, a 14-yea -old wi h
acu e leukemia, was diagnosed wi h HCV geno ype 1. Despi e ini ial success ul ea men wi h ledipas i /so osbu i ,
HCV RNA eappea ed wi hin 12 weeks o comple ing he he apy. The pa ien was subsequen ly ea ed wi h
so osbu i / elpa as i , esul ing in sus ained i ologic esponse (SVR) a 12 and 24 weeks. Pa ien 2, a 5-yea -old wi h
os eosa coma, was diagnosed wi h HCV geno ype 3. A e expe iencing a elapse ollowing ea men wi h
so osbu i /dacla as i , he pa ien was success ully e ea ed wi h so osbu i / elpa as i , achie ing unde ec able HCV
RNA le els a ollow-up. These cases unde sco e he impo ance o ea ly de ec ion and igilan ollow-up in pedia ic
oncology pa ien s wi h HCV, as well as he po en ial o success ul e ea men wi h pangeno ypic DAA egimens like
so osbu i / elpa as i . Gi en he e ol ing na u e o pedia ic HCV ea men , u he esea ch is c ucial o op imizing
ea men s a egies o his ulne able popula ion.
Keywo ds: Hepa i is C; Di ec -Ac ing An i i als; So osbu i /Velpa as i ; T ea men Failu e; Re ea men
1. In oduc ion
Cu en ly, he e a e 3 o 3.5 million child en globally a e in ec ed by hepa i is C i us (HCV) (1). Ia ogenic ansmission
pa icula ly ia blood ans usion emains he mos impo an isk ac o in de eloping coun ies among child en
needing egula ans usions (2). P e iously, be o e he widesp ead blood dono sc eening ha began in he ea ly
1990s, i was shown ha 6 o 50% o child en unde going ea men o leukemia es ed posi i e o HCV RNA (3). E en
in he 2000s, pedia ic oncology g oups con inued o be a a highe isk o con ac ing he in ec ion, pa icula ly in
unde - esou ced a eas (3). In such pa ien s, in ec ion wi h HCV poses challenges o cance managemen as
immunosupp ession can inc ease i al ac i i y leading o dele e ious complica ions such as ci hosis and li e ailu e
(3). The p e alence o HCV a ies ac oss a ious demog aphics in I aq (4-7). Signi ican e o s a e unde way in some
egions o achie e he objec i e o HCV e adica ion by 2030 (8, 9). The disco e y o di ec -ac ing an i i al (DAA)
medica ions acili a es he a ainmen o his objec i e. The mains eam o HCV ea men has signi ican ly been
changed by he disco e y o DAAs. In adolescen s, DAA egimens ha do no con ain in e e on o iba i in a e bo h
sa e and e ec i e (2). Nume ous combina ions a e cu en ly pe missible o pedia ic use. So osbu i -based ea men s
show a sus ained i ologic esponse (SVR) a es o 95% in child en aged 3 yea s o olde wi hou any majo side e ec s
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 775-778
776
(10, 11). A s udy ha in ol ed mul i-cen e s ha used so osbu i / elpa as i in 216 child en (ages 3–17)
demons a ed an SVR a 12 mon hs (SVR12) a e o app oxima ely 92% (11). Besides, a combina ion o
ledipas i /so osbu i cu ed 98–100% o child en wi h HCV geno ype 1 o 4, including hose wi h malignancy (12).
Howe e , despi e he high cu e a es, ecu ence o in ec ion is s ill possible. P e ious s udies showed di e en easons
o ea men ailu e including esis ance mu a ions, inadequa e adhe ence, o ein ec ion (13, 14). In his s udy, we
discuss wo pedia ic oncology pa ien s wi h ans usion- ela ed HCV who expe ienced a elapse a e DAA he apy bu
had a posi i e esponse o e ea men wi h so osbu i / elpa as i .
2. Case Repo
2.1. Pa ien 1
A 14-yea -old boy in emission wi h acu e leukemia, was ound o be HCV-posi i e inciden ally du ing ou ine check-
up. The diagnosis was con i med by HCV-RTPCR ha showed a i al load o 1.2×10^6 IU/mL o geno ype 1. Fu he
in es iga ions showed ha he pa ien is no co-in ec ed wi h hepa i is B o HIV. Addi ionally, he physical examina ion
o he pa ien was un ema kable. In es iga ions showed no mal li e unc ion es (ALT le els o 30 U/L, AST le els o
28 U/L, and no mal le els o bili ubin and albumin). Besides, an abdominal ul asound demons a ed a la li e
mo phology wi h minimal enla gemen wi hou asci es. Then, he pa ien was p esc ibed ledipas i /so osbu i (90
mg/400 mg once daily), o a pe iod o 12 weeks. He epo ed no ad e se e ec s and ole a ed he d ug well. A e ou
weeks o ea men , he HCV RNA le el demons a ed a subs an ial dec ease. The pa ien 's HCV RNA was unde ec able
a he end o he ea men cou se. Howe e , wel e weeks a e he comple ion o medica ion, a quan i a i e PCR
ollow-up e ealed he p esence o he i us (Table 1), which indica es ea men ailu e. Fo e ea men , he pa ien
was gi en so osbu i / elpa as i (400 mg/100 mg once daily) o wel e weeks. HCV RNA was unde ec able a e ou
weeks o ea men wi h so osbu i / elpa as i and a he end o ea men cou se. A e comple ion o he ea men
a he 12 h and 24 h weeks o ea men , cu e was con i med wi h main enance o unde ec able HCV RNA.
2.2. Pa ien 2
Following umo excision and ea men , a 5-yea -old child wi h a his o y o os eosa coma was diagnosed wi h ch onic
hepa i is C du ing ollow-up es s. The i al load was measu ed a 4.8×10^5 IU/mL by HCV RNA PCR wi h HCV geno ype
3 and no co-in ec ion wi h hepa i is B o HIV. Upon examina ion, he child was a well-appea ing wi h some dis ess in
he igh uppe quad an . In addi ion, o he in es iga ions showed li e enzymes we e sligh ly ele a ed (ALT 45 U/L,
AST 48 U/L). Besides, abdominal ul asonog aphy showed hepa omegaly. The pa ien was gi en a daily egimen o
so osbu i 200 mg and dacla as i 30 mg o 12 weeks. HCV RNA was unde ec able a 4 weeks a e ea men and a
he conclusion o ea men cou se. Howe e , he i us had esu aced 12 weeks a e he conclusion o ea men (Table
1). Then he pa ien was e ea ed wi h so osbu i / elpa as i (so osbu i 200 mg + elpa as i 50 mg once daily) o
wel e weeks. Fu he mo e, HCV RNA es ing was nega i e a e he ou h week o e ea men and emained
unde ec able un il he 12-week pe iod concluded. Following up he pa ien showed unde ec able HCV RNA a 12 and 24
weeks a e ea men comple ion.
Table 1 The cha ac e is ics o ec ui ed pa ien s
No
1
2
Age in yea s
14
5
Sex
male
male
Weigh in kg
45
20
Geno ype
1
3
T ea men
ledipas i 90 mg /
so osbu i 400 mg
Dacla as i 30 mg /
so osbu i 200 mg
Pos -
ea men
RTPCR
IU/mL
1 mon h
nega i e
nega i e
12 weeks
nega i e
nega i e
12 weeks a e
comple ion o
ea men
833
3691
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 775-778
777
3. Discussion
Ou cases show he impo ance o conside ing essen ial elemen s when managing HCV in ec ions in pedia ic oncology
pa ien s. Fi s ly, i is impo an o conside ha child en ecei ing cance ea men con inue o be a highe isk o
HCV in ec ion. The e is a g ea possibili y ha ou cases in his s udy we e likely o con ac he in ec ion because o he
mul iple blood ans usions adminis e ed du ing hei leukemia and os eosa coma ea men s. Al hough he incidence
o HCV ansmi ed h ough ans usions has lessened since he 1990s, isola ed cases s ill occu , especially in a eas wi h
limi ed sc eening o wi hin he acu e in ec ion phase o dono s. Such cases emphasize he need o s ic sc eening in
child en unde going ex ensi e ans usion he apy o enable ea ly in e en ion and minimize li e damage du ing
chemo he apy (3).
Secondly, while ea men wi h DAA medica ions ca ies high success a es, ea men ailu e is s ill possible. Al hough
bo h pa ien s had an unde ec able i us ini ially, hey bo h expe ienced a elapse wi hin 12 weeks o s a ing ea men .
Addi ionally, ailu e o ini ial ea men migh be explained by poo adhe ence o he p esence o baseline esis ance.
NS5A inhibi o s like ledipas i and dacla as i can lead o esis ance-associa ed subs i u ions (RAS) in geno ypes ha
a e oughe o ea , such as geno ype 3 (15). Besides, pa ien 2, who belonged o geno ype 3 HCV in ec ion, may ha e
ha bo ed he Y93H RAS linked o dacla as i ea men ailu e. In ou coun y, esis ance es ing is no o en a ailable,
leading o limi ed alida ion o hese cases. Pa ien 2 was p esc ibed o -label so osbu i /dacla as i due o he
una ailabili y o o he op ions a he ime. His ini ial esponse o he adjus ed dose indica es ha he has ecei ed an
adequa e amoun o medica ion. Consequen ly, esis ance is mo e likely han unde dosing. Bo h cases we e e ea ed
wi h so osbu i / elpa as i . Such a pangeno ypic combina ion o e s a supe io esis ance ba ie and b oad e icacy
by a ge ing NS5B and NS5A (10). Repo edly, such a combina ion ca ies a e y high cu e a es bo h in adul s and
child en (11, 12). Ou expe ience u he suppo ed ha such a combina ion se es as a easible sal age ea men in
pedia ic se ings ollowing DAA ailu e. Addi ionally, i was p e iously shown ha DAA combina ions a e associa ed
wi h minimal side e ec s (10, 11). In suppo o his, bo h pa icipan s did no exhibi any ad e se symp oms.
Fu he mo e, ou cases in his s udy showed he impo ance o subsequen PCR es ing ollowing he apy. Due o he
high success a es o DAA combina ions, some physicians may abandon p ope ollow up may be emp ed o belie e in
a cu e due o he high success a es o DAA.
4. Conclusions
I is impe a i e ha child en wi h cance a e a high isk o con ac ing blood-bo ne in ec ions pa icula ly HCV. Such a
isk manda es p omp diagnosis and ea men , as he ea men o HCV can alle ia e he su e ing o his a - isk
popula ion. The e o e; his esea ch sugges s ha physicians should be igilan o he in ec ion and he ea men
ailu es. Besides, his s udy showed ha e ea men wi h a pangeno ypic DAA egimen, such as so osbu i / elpa as i ,
can e ec i ely elimina e he i us. I is impo an o men ion ha con inuous esea ch and he exchange o expe iences
in pedia ic HCV e ea men will con ibu e o he u he de elopmen o op imal p ac ices, he eby enabling all
child en—including hose who do no espond o i s -line he apy o be ea ed wi h e ec i e egimens.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e no con lic s o in e es .
S a emen o e hical app o al
The e hics commi ee o he College o Medicine, Uni e si y o Zakho app o ed he p esen a ion o hese wo cases.
S a emen o in o med consen
In o med consen was ob ained om he pa en s o legal gua dians o he pedia ic pa ien s o pe mi he elease o
hei anonymized clinical in o ma ion and hei pa icipa ion. To p o ec pa ien con iden iali y, all pe sonal
in o ma ion was emo ed. The Na u e o his s udy is e ospec i e analysis o clinical da a, wi h no expe imen al
in e en ions exceeding s anda d medical ca e.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 775-778
778
Re e ences
[1] Schmelze J, Dugan E, Blach S, Coleman S, Cai Z, DePaola M, e al. Global p e alence o hepa i is C i us in child en
in 2018: a modelling s udy. The lance Gas oen e ology & hepa ology. 2020;5(4):374-92.
[2] Honegge JR, Gowda C. De e no mo e: ad ances in he ea men and p e en ion o ch onic hepa i is C i us
in ec ion in child en. Cu en opinion in in ec ious diseases. 2022;35(5):468-76.
[3] Jakha N, Ge a A, Mi al R, Mehndi a a S, Singh A. T ea men o hepa i is C in a case o pedia ic B-cell acu e
leukemia. Jou nal o Global In ec ious Diseases. 2022;14(1):35-7.
[4] Hussein NR. P e alence o HBV, HCV and HIV and An i-HBs an ibodies posi i i y in heal hca e wo ke s in
depa men s o su ge y in Duhok Ci y, Ku dis an Region, I aq. In e na ional Jou nal o Pu e and Applied Sciences
and Technology. 2015;26(2):70.
[5] Hussein NR, Haj SM, Almizo i LA, Taha AA. The p e alence o hepa i is B and C i uses among blood dono s
a ending blood bank in Duhok, Ku dis an egion, I aq. In J In ec . 2017;4(1):e39008.
[6] Hussein NR, Saleem Z. Success ul ea men o hepa i is C i us geno ype 4 in enal ansplan ecipien s wi h
di ec ‐ac ing an i i al agen s. Ame ican Jou nal o T ansplan a ion. 2016;16(7):2237-8.
[7] Ib ahim N, Saleem ZSM, Hussein NR. The P e alence o HIV, HCV, and HBV among hemodialysis pa ien s
a ending Duhok Hemodialysis Cen e . In e na ional Jou nal o In ec ion. 2018;5(1).
[8] Hussein NR, Daniel S, Mi khan SA, Saleem ZSM, Musa DH, Ib ahim N, e al. Impac o he Co id-19 pandemic on
he elimina ion o hepa i is C i us in Duhok, Ku dis an, I aq: a e ospec i e c oss-sec ional s udy. Jou nal o
amily medicine and p ima y ca e. 2020;9(12):6213-6.
[9] Jamal SA, Naqid IA, Hussein NR, Abdulqade SR, Nime AA, Abdulkhdai HA, e al. The P e alence o Hepa i is B
and C Vi us In ec ions in he Couples A ending a P ema i al Sc eening P og am in Zakho Ci y, Ku dis an Region
o I aq. Zahedan Jou nal o Resea ch in Medical Sciences. 2020(In P ess).
[10] B igham D, Na kewicz MR. P o ile o so osbu i and elpa as i combina ion in he ea men o ch onic hepa i is
C in child en and adolescen s: cu en e idence. The apeu ics and Clinical Risk Managemen . 2024:1-7.
[11] Jonas MM, Rome o R, Rosen hal P, Lin CH, Ve ucchi G, Wen J, e al. So osbu i – elpa as i in child en 3–17 yea s
old wi h hepa i is C i us in ec ion. Jou nal o pedia ic gas oen e ology and nu i ion. 2024;78(6):1342-54.
[12] AbouBak O, Ezz El Regal M, Sa han AA, El Sayed Zaki M, Noaman A. Sa e y and e icacy o ledipas i /so osbu i
in he ea men o ch onic hepa i is C i us in ec ion in ea men -naï e child en wi hou and wi h
como bidi ies. Pedia ic D ugs. 2022;24(5):529-37.
[13] Panel A-IHG. Hepa i is C Guidance 2018 Upda e: AASLD-IDSA Recommenda ions o Tes ing, Managing, and
T ea ing Hepa i is C Vi us In ec ion. Clinical In ec ious Diseases. 2018;67(10):1477-92.
[14] Sa azin C. T ea men ailu e wi h DAA he apy: Impo ance o esis ance. Jou nal o Hepa ology.
2021;74(6):1472-82.
[15] Di Maio VC, Cen o V, Lenci I, A ag i M, Rossi P, Ba baliscia S, e al. Mul iclass HCV esis ance o di ec -ac ing
an i i al ailu e in eal-li e pa ien s ad oca es o ailo ed second-line he apies. Li e In . 2017;37(4):514-28.
