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Hepatitis C Virus in Children: Deferring Treatment in Expectation of Direct-Acting Antiviral Agents

Esther Granot, Etienne M Sokal

    The Israel Medical Association Journal : IMAJ
    |January 14, 2016
    PubMed

    Insights

    Vertical transmission is the main route for pediatric hepatitis C virus (HCV) infection. While most children clear the virus spontaneously, treatment is reserved for high-risk cases due to potential side effects.

    Area of Science:

    • Pediatric Infectious Diseases
    • Hepatology
    • Virology

    Background:

    • Hepatitis C virus (HCV) infection in children primarily occurs vertically from mother to infant.
    • Pediatric HCV infection often results in spontaneous clearance, mild disease, and slow progression to cirrhosis (1-2%) over decades.

    Purpose of the Study:

    • To review the natural course, treatment outcomes, and emerging therapies for pediatric hepatitis C virus (HCV) infection.
    • To inform clinical management strategies for children with HCV.

    Main Methods:

    • Review of existing literature on pediatric HCV infection, including transmission, natural history, and treatment efficacy.
    • Analysis of outcomes associated with pegylated interferon (Peg-IFN) + ribavirin therapy.
    • Consideration of ongoing research into direct-acting antiviral agents (DAAs).

    Main Results:

    • High spontaneous clearance rates in children with HCV.
    • Peg-IFN + ribavirin achieves 100% sustained viral response (SVR) for genotypes 2/3, but only 45-55% for genotypes 1/4.
    • Treatment is linked to various adverse effects, including anemia and neuropsychiatric symptoms.

    Conclusions:

    • An expectant approach is generally recommended for pediatric HCV.
    • Treatment decisions should consider individual risk factors for progressive liver disease.
    • Direct-acting antiviral agents (DAAs) show promise for future pediatric HCV treatment with improved safety and efficacy.

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