Hepatitis C virus in childhood and pregnancy

Infection with hepatitis C virus (HCV) represents a continued worldwide health concern. There are an estimated 50 to 71 million people living with HCV worldwide. This number continues to fall with availability of curative treatment, and there is now a stated goal to reduce infections by 90% and deaths by 65% worldwide by 2030. Annual mortality estimates for HCV and its complications range from 230,000 to 400,000. Although these longer term complications are more prevalent in adults than children, HCV in pediatric patients remains a public health concern. An 8- to 12-week course of direct-acting antiviral medications can produce a sustained viral response rate of 95% to 99% (an increase from the 50% rate with prior pegylated interferon and ribavirin). Pregnant women and children represent 2 classes of patients for whom antiviral therapy has not been widely applied. Although children over 3 years of age now can be treated with direct-acting antivirals, pregnant patients are screened but not routinely treated for HCV. Close linkage to care during the prenatal period or after delivery with follow-up for mother and child remains paramount. In this review we highlight a brief history of HCV, the difficulty of assessing the burden of disease in pregnancy and childhood, the risk of mother-to-child transmission, the revised 2024 Centers for Disease Control and Prevention testing guidance, care in pregnancy, burden of children co-infected with HCV and hepatitis B virus or human immunodeficiency virus, treatment regimens for children and adolescents, and prospects for vaccine development.