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Hepatitis C in childhood
1Paediatric Gastroenterology and Hepatology, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia. hardikaw@cryptic.rch.unimelb.edu.au
Insights
Pediatric management of hepatitis C virus (HCV) differs due to long-term uncertainty. Current treatment focuses on children with significant liver fibrosis and inflammation.
Area of Science:
- Pediatric Hepatology
- Virology
- Public Health
Background:
- Hepatitis C virus (HCV) management in children presents unique challenges compared to adults, involving a chronic illness with uncertain long-term outcomes.
- Prevalence of chronic HCV in children is low but varies regionally, with perinatal transmission being the primary route in most countries.
- Post-transfusion HCV risk is minimized in many regions due to blood product screening.
Purpose of the Study:
- To outline the distinct approach required for managing pediatric hepatitis C virus (HCV) infection.
- To discuss the current understanding of HCV natural history, transmission, and treatment considerations in children.
- To highlight the factors influencing treatment decisions and prevention strategies for pediatric HCV.
Main Methods:
- Review of current literature on pediatric HCV management.
- Analysis of transmission routes, including perinatal and blood-borne.
- Evaluation of histological findings and long-term prognosis in pediatric cases.
Main Results:
- Most children with HCV show mild histological changes; cirrhosis is rare.
- Perinatal transmission is the predominant source, with a transmission risk of approximately 6%.
- Antiviral treatment decisions are complex due to unclear long-term outcomes, with current recommendations targeting significant fibrosis.
Conclusions:
- Pediatric HCV management requires a long-term perspective, differing significantly from adult practice.
- Treatment should be reserved for children with significant hepatic fibrosis and necroinflammatory changes.
- Prevention strategies, such as exploring the role of cesarean sections, are under investigation, while breastfeeding is not considered a risk.
Abstract:
The approach of a pediatric hepatologist in managing children with hepatitis C virus (HCV) differs from adult practice, because the pediatric hepatologist is dealing with the beginning of a chronic illness in which long-term outcomes will not occur for 20 or 40 years, and it is not possible to predict in the early stages of the infection which patients have a more sinister prognosis. The prevalence of chronic HCV in children is low, but varies between different countries in the Asia-Pacific region. In most countries, screening of blood products for HCV has virtually eliminated the risk of post-transfusion HCV, so that in Australia children aged less than 11 years will not have acquired HCV from blood transfusion or extracorporeal membrane oxygenation. The risk of perinatal transmission of this virus is only about 6%, but this remains virtually the only source of HCV transmission for children in most countries. While available data are limited, mild histological changes are present in the majority of children with hepatitis C, and cirrhosis is rare. Unfortunately, long-term natural history studies of the course of HCV infection in children have not been reported. Individual decisions on antiviral treatment are more difficult in childhood, not because the treatment is any less effective or because of the severity of side-effects (which tend to be less severe than for adults), but because the long-term outcome of infection is unclear. At present, treatment should be confined to those with significant hepatic fibrosis and continued moderate to severe necroinflammatory change. Measures to prevent HCV infection in childhood center on whether, as recently suggested, elective cesarean section may reduce the risk of transmission. Despite the presence of HCV-RNA in some breast milk samples, there is no evidence that breast-feeding confers any risk of HCV infection.