Autoimmune Hepatitis After Successful Treatment of Chronic Hepatitis C Virus Infection with Direct-Acting Antivirals: A Pediatric Case Report

More than 3 million children are infected with hepatitis C virus (HCV) worldwide. Therapies with direct-acting antivirals (DAAs) are characterized by high efficiency and acceptable tolerability. Rare cases of autoimmune hepatitis (AIH) following HCV elimination have been reported in adults. Here, we present the first pediatric case of AIH after successful treatment with DAAs. A girl, born in 2012, was diagnosed with vertical HCV infection in 2013. In 2023, she was treated with the DAA glecaprevir/pibrentasvir. HCV RNA was undetectable after 4 weeks of treatment and at the end of treatment (EOT). However, at the EOT, the aminotransferase concentration elevated with further increase, despite a confirmed sustained viral response (SVR) 12 weeks after the EOT. Gamma-globulins were elevated, with positive anti-nuclear antibodies (ANA) and anti-liver kidney microsome (LKM) antibodies. Other causes were excluded. Elastography revealed no fibrosis. Aminotransferase levels decreased but did not normalize. A liver biopsy was performed, confirming a diagnosis of AIH. Immunosuppressive therapy with prednisone and azathioprine resulted in normalization of aminotransferase levels, and the titers of both ANA and LKM antibodies decreased. Monitoring aminotransferase levels should not be omitted in patients after successful DAA treatment of HCV infection.