Management of Viral Hepatitis C in Children

Abstract

Once hepatitis C virus (HCV) infection has infected a child, the risk of chronicity seems as high as in adults, i.e., 60–80%. Although symptomatic disease is rare and histological progression is in most cases slower than for adults, advanced fibrosis or in fact cirrhosis is noted in 2–5% by adolescence (Bortolotti F, Verucchi G, Cammà C, Cabibbo G, Zancan L, Indolfi G et al. Gastroenterology 134:1900–1907, 2008; Guido M, Bortolotti F, Leandro G, Jara P, Hierro L, Larrauri J et al. Am J Gastroenterol 98:660–663, 2003; Goodman ZD, Makhlouf HR, Liu L, Balistreri W, Gonzalez-Peralta RP, Haber B et al. Hepatology 47:836–843, 2008; Jara P, Resti M, Hierro L, Giacchino R, Barbera C, Zancan L et al. Clin Infect Dis 36:275–280, 2003). This would suggest that antiviral treatment during childhood or adolescence can be beneficial. Furthermore, if such treatment is successful, i.e., eradicates the infection, the future risks of transmitting the infection to sexual partners or offspring are eliminated. Additionally, there is usually no need for further follow-up after successful treatment with the achievement of sustained viral response (SVR) 12–24 weeks after cessation. The one exception is the continuous need for screening for hepatocellular carcinoma if cirrhosis was detected before treatment (Gonzalez-Peralta RP, Langham MR, Andres JM et al. J Pediatr Gastroenterol Nutr 48:630–635, 2009).

So far, all treatment modalities have first been tried in adults and thereafter in children. This is true for interferon (IFN) monotherapy, combination therapy with IFN (conventional or pegylated (PEG)) and ribavirin (RBV), as well as for the recently available IFN-free combinations of direct-acting antiviral (DAA) agents without or with RBV. For each new treatment modality, improved SVR rates have been reported, and results for children have often been slightly better than for adults. This might be attributed to shorter duration of infection, lower viral loads, and relatively fewer concomitant diseases in children.