Histopathological features and eight-week split-tablet sofosbuvir/velpatasvir treatment in young children with acute hepatitis C: a case-series study

Data on the clinical features and treatment of young children with acute hepatitis C (AHC) remain limited. This case-series report describes the clinical characteristics, histopathological findings, and treatment responses of two young children with AHC, aiming to provide insights for future research and clinical practice. We evaluated two four-year-old children who acquired AHC through unsafe injection practices. The clinical decision-making process and management strategies were documented, and both children underwent liver biopsy. They received an eight-week course of sofosbuvir/velpatasvir (200/50 mg; ½ tablet, tablet-split, once daily). The primary efficacy endpoint was sustained virologic response (SVR12), defined as undetectable HCV RNA 12 weeks after completing treatment. Adverse events were monitored throughout the therapy period. Both children were asymptomatic at diagnosis. Baseline HCV RNA levels were 1,500 IU/mL and 2,300 IU/mL, with alanine aminotransferase (ALT) levels of 316 U/L and 15 U/L, respectively. Liver biopsy revealed mild inflammation with moderate fibrosis (G1S2) in child 1 and moderate inflammation with mild fibrosis (G2S1) in child 2. By the first week of therapy, ALT levels normalized in both cases; HCV RNA declined to 49.2 IU/mL in child 1 and became undetectable in child 2. By week 2, HCV RNA was undetectable in child 1. At 12 weeks after treatment completion, both achieved SVR12, with no treatment-related adverse events and stable laboratory parameters throughout. To our knowledge, this is the first report clearly demonstrating that AHC in young children can cause histological liver injury. An eight-week tablet-split regimen of sofosbuvir/velpatasvir appeared safe, well tolerated, and effective in these two cases. Further studies are warranted to validate these findings in the broader pediatric population.