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Management Strategies for Hepatitis C Virus Infection in Children

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Abstract

Chronic hepatitis C virus (HCV) infection is a major cause of morbidity and mortality worldwide. Progression to cirrhosis and hepatocellular carcinoma occurs in 20% of infected adults. The natural history following childhood infection is less well defined, although cirrhosis in children is described. Since blood product screening for HCV infection was introduced in 1990, most children who acquire HCV do so by vertical transmission from an infected mother. Transmission to offspring occurs in approximately 5%.

Most children with HCV infection are asymptomatic. Diagnosis is made by testing those at risk for HCV RNA by polymerase chain reaction (PCR) and HCV antibody (anti-HCV) by enzyme immunoassay (EIA). The clinical impact of HCV infection is assessed by monitoring symptoms and signs, blood testing of liver enzymes, ultrasound imaging, and by liver biopsy.

Improved efficacy and tolerability of treatment strategies in adults have had a significant impact on the management of children with HCV infection. The emphasis is now on promoting awareness, early diagnosis, and treatment. Treatment strategies have evolved from monotherapy with interferon alfa (IFNα), to combination therapy with ribavirin. Pegylated IFNα is superior to conventional IFNα, and forms the basis of current recommendations. The genotype of HCV influences treatment efficacy. Treatment is generally well tolerated in children, although adverse effects are common. Preparation and support throughout treatment for the whole family is needed.

A proportion of children with HCV infection have co-morbidity, including viral co-infection or hematologic disease. Although treatment may be contraindicated, risks and benefits must be considered before denying treatment. Anemia is more common in those with HIV co-infection, renal insufficiency, thalassemia, or cirrhosis, and may be aggravated by treatment. Children with thalassemia may have iron overload, and transfusion requirements may increase during treatment.

Further refinements of combination therapy and development of new drugs are in progress. Vaccine candidates are undergoing phase I and II treatment trials.

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Acknowledgements

No sources of funding were used to assist in the preparation of this article. Deirdre Kelly has received educational grants to organize clinical trials in children with viral hepatitis from GlaxoSmithKline, Bristol Myers Squibb, Schering-Plough, Roche, and Gilead Science. She provides advice as a consultant to Novartis. Suzanne Davison has no conflicts of interest that are directly relevant to the content of this article.

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Correspondence to Dr Suzanne M. Davison.

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Davison, S.M., Kelly, D.A. Management Strategies for Hepatitis C Virus Infection in Children. Pediatr-Drugs 10, 357–365 (2008). https://doi.org/10.2165/0148581-200810060-00003

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Keywords

  • Thalassemia
  • Darbepoetin Alfa
  • Sustained Viral Response
  • Polyethylene Glycol Moiety
  • Infected Blood Product