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Background Chronic HCV infection is asymptomatic in CY&P with rare cases of advanced fibrosis & hepatic failure. The central nervous system impact of HCVin adults is well described, with both systemic immune activation and viral replication implicated. 1 There has been little focus on neurodevelopmental data for CY&P living with HCV, yet they face exposure to both maternal systemic inflammation in utero and to HCV & immune activation throughout the critical period of infant brain growth in the first 2 years of life.Maternal inflammation from both infective & inflammatory triggers is associated with an increased risk of neurocognitive & psychiatric disorders in childhood.2 Additionally, infants born to women living with HCV are more likely to experience in utero substance use exposure, with the potential for further neurocognitive sequalae associated with neonatal abstinence & fetal alcohol syndromes.3 Neurocognitive deficits in children appear to correlate with levels of plasma inflammatory cytokines, including comprehension and vocabulary.4 The impact of DAAs on childhood neurocognitive functioning, requires elucidation.Methods Retrospective review of e-referrals to HCV pMDT ODN between 04/21 to 09/24Data collected: •Clinical & demographic data ; • Co-morbidities; •Neurodevelopmental & behavioural difficulties (after 04/23) •Issues affecting adherence; •DAA formulation; •OutcomesComparative data reported: Group 1: No reported learning & behavioural difficulties (NLD); Group 2: Reported learning & behavioural difficulties (LD)Results 141 HCV+ve C&YP referred to the pMDT ODN:Group 1 n= 112 (NLD). Group 2 n-29 (LD)Abstract OC28 Table 1Comparative data Group 1 Group 2 Genotype • 1 • 2 • 3 • 4545494 131141 Median (range) age years 8.6 (3 - 17.8) 8.1 (3.2 - 13.3) Gender 61M 13M Ethnicity • Caucasian • Asian • Unknown • African • Others64211449 262----1 Transmission • Vertical • Horizontal • Unknown10723 281-- Formulation prescribed • Tablets • Granules7735 1712 Abstract OC28 Table 2Treatment outcome Group 1 v Group 2 Group 1 Group 2 Treated 99 23 Treatment milestones*• End of Treatment• SVR12• 12mSVR9082/9061/82 2116/2110/16 Treatment not started• Recently approved• Awaiting feedback• Family no longer in UK• Child refusing treatment4612 2004 Blood monitoring• None• Child refusing**• Difficulties obtaining bloods**• DNA appointments***• Lost to follow up***961011 17114-- *Outcome where specific end point has been reached**Clinicians working with support teams***Working with health agencies to locate familiesAbstract OC28 Table 3Summary of findings in Group 2 Findings Behavioural/Learning difficulties4/4Foetal Alcohol syndrome/neonatal drug withdrawal7/6Attention Hyperactivity Deficiency/Autistic Spectrum Disorder9/12Global developmental delay4Summary Learning & behavioural difficulties were reported in 21% compared to estimated rates of 2.5–4% in the general UK school aged population. There was no significant difference in demographics or treatment response; children with LD had more difficulty attending clinic and taking the medication.Conclusion The potential role of maternal-infant HCV infection on neurocognitive outcomes requires elucidation for optimal timing of HCV therapy, currently not licensed until age 3+ years & to determine the risk benefit of maternal HCV clearance in pregnancy.References Radkowski M, Kryczka T, Szymańska-Kotwica B, Berak H, Horban A, Pawłowski T, Perlejewski K, Laskus T. Depression and cognitive dysfunction in patients with chronic hepatitis C: correlation with viral replication in the peripheral blood mononuclear cells and cytokines in serum. Int J Mol Sci. 2023 Oct 19;24(20):15351.Kwon HK, Choi GB, Huh JR. Maternal inflammation and its ramifications on fetal neurodevelopment. Trends Immunol. 2022 Mar;43(3):230–244.Woodworth KR, Newton SM, Tannis A, Reynolds MR, Olsen EO, Sizemore L, Wingate H, Orkis L, Reynolds B, Longcore N, Thomas N, Kim SY, Panagiotakopoulos L, Wester C, Delman DM, Gilboa SM, Tong VT. Birth outcomes among people with hepatitis C in pregnancy - three U.S. states, 2018–2021. Matern Child Health J. 2024 Jun;28(6):979–983.Abu Faddan NH, Shehata GA, Abd Elhafeez HA, Mohamed AO, Hassan HS, Abd El Sameea F. Cognitive function and endogenous cytokine levels in children with chronic hepatitis C. J Viral Hepat. 2015;22(8):665–670. doi:10.1111/jvh.12373