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State of the Art HCV Treatment in Children

  • Christine K. LeeEmail author
  • Maureen M. Jonas
Hepatitis C (H Vargas and S Flamm, Section Editors)
  • 4 Downloads
Part of the following topical collections:
  1. Topical Collection on Hepatitis C

Abstract

Purpose of Review

Hepatitis C infection is a global issue with an estimated 5 million children with active HCV infection worldwide. The advent of oral direct-acting antiviral (DAA) regimens has revolutionized treatment in adults with excellent efficacy and tolerability. There are limited data and few approved therapies in children. The aim of this review is to discuss the currently approved regimens for children and the recently reported results of clinical trials of DAA in children.

Recent Findings

DAA regimens are currently approved only for children ≥ 12 years. For most children < 12 years, it is recommended that HCV therapy be deferred until patients are eligible for oral DAA therapies. For treatment-naïve adolescents with HCV genotype 1, 4, 5, or 6, treatment with ledipasvir/sofosbuvir for 12 weeks has been reported to have sustained virologic response at 12 weeks of 98%. For treatment-naïve adolescents with genotype 2 or 3 HCV, sofosbuvir- ribavirin combination therapy (12 weeks for genotype 2 and 24 weeks for genotype 3) has been reported to have SVR12 of 100% and 97%, respectively. There are promising, recently published studies showing excellent SVR12 rates for ombitasvir/paritaprevir/ritonavir ± dasabuvir ± ribavirin in adolescents with HCV genotype 1 or 4, and sofosbuvir/daclatasvir in children/adolescents with HCV genotype 4. Finally, ledipasvir/sofosbuvir ± ribavirin for children age 6–12 years with genotypes 1, 3, 4, 5, and 6 treated for either 12 or 24 weeks is reported to have an SVR12 rate of 99%.

Summary

HCV treatment in children is rapidly evolving. There are now highly effective all-oral, interferon-free regimens for children ≥ 12 years. Clinical trials are on-going for adolescents and children < 12 years with a variety of pangenotypic ribavirin-free regimens, with anticipated approvals in the near future.

Keywords

Pediatric Children Hepatitis C HCV Treatment Direct-acting antiviral 

Notes

Compliance with Ethical Standards

Conflict of Interest

Maureen M. Jonas reports grants from Gilead Sciences, grants from AbbVie, grants from Merck, grants from Bristol Myers-Squibb, grants from Roche, and personal fees from Gilead Sciences, outside the submitted work. Christine K. Lee received research support in the form of transient elastography hardware from Echosens; no other support was given.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology, Hepatology and NutritionBoston Children’s HospitalBostonUSA

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