Pegylated interferon and ribavirin gone but not forgotten in the era of direct-acting antivirals

Minerva Pediatr (Torino). 2022 Feb;74(1):23-30. doi: 10.23736/S2724-5276.20.05881-8. Epub 2021 Jan 13.


Background: Therapy with pegylated interferon and ribavirin (PEG-IFN+RBV) for chronic hepatitis C (CHC) remains the only option available for children in many Eurasian and European countries. Our aim was to evaluate the influence of host and viral factors on response to IFN-based therapy to optimize it for those in whom directly acting antivirals (DAA) are currently unavailable.

Methods: Seventeen vertically infected, treatment naive children (10 male and 7 female) aged 5-16 years with CHC underwent a course of PEG-IFN+RBV. The end point was sustained virologic response (SVR). Host and virus factors were divided into pre- and on-treatment predictors of response to therapy.

Results: Eleven patients obtained SVR (64%), 4 were non-responders (23%), and 2 were relapsers (12%). Significant relationship was found between HCV RNA elimination and following variables: virus genotype and early virologic response (EVR) (P<0.037, P<0.029 respectively). Higher eradication rate was observed in patients infected with genotype 3 HCV (100% vs. 65% with genotype 1 or 4), and in those with undetectable HCV RNA by week 12 (88% vs. 66% with viremia). EVR was associated with SVR (83% vs. 0% in nonresponders; P<0.004). C allele of IL28B rs12979860 was a predictor of EVR (P<0.043). The SVR rates among CC, CT, and TT carriers were as follows: 75%, 67%, and 33%.

Conclusions: Detection of favorable HCV and IL28B genotype prior to commencement of PEG-IFN+RBV and continuing it in patients with EVR is of major importance for those in whom DAA are still unavailable.

MeSH terms

  • Adolescent
  • Antiviral Agents / pharmacology
  • Antiviral Agents / therapeutic use
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Female
  • Hepacivirus / genetics
  • Hepatitis C, Chronic* / drug therapy
  • Hepatitis C, Chronic* / genetics
  • Humans
  • Interferon alpha-2 / therapeutic use
  • Interferon-alpha / pharmacology
  • Interferon-alpha / therapeutic use
  • Male
  • Polyethylene Glycols / pharmacology
  • Polyethylene Glycols / therapeutic use
  • Ribavirin* / pharmacology
  • Ribavirin* / therapeutic use
  • Treatment Outcome


  • Antiviral Agents
  • Interferon alpha-2
  • Interferon-alpha
  • Polyethylene Glycols
  • Ribavirin