Cascade of care for children and adolescents with chronic hepatitis C

Abstract

Chronic hepatitis C virus (HCV) infection presents a significant global public health burden. In 2015, over 400000 deaths worldwide were attributed to HCV infection. This led the World Health Organization (WHO) in 2016 to set the ambitious goal of eliminating HCV by 2030. Adult-centered guidelines have been established in order to provide direction for healthcare professionals, allowing integration of the newest screening policies and therapeutic strategies into their practices. However, for children and adolescents, HCV is a significant, unrecognized public health problem. HCV infection rates in the United States in women of childbearing age and those who are pregnant have increased in parallel with the rising opioid epidemic. An estimated 29000 women with HCV infection gave birth each year from 2011 to 2014 in the United States, with approximately 1700 of their infants being infected with HCV. Newer HCV-specific therapeutics, namely direct acting antivirals (DAA), has brought a new and highly successful approach to treatment of hepatitis C. Recent studies have confirmed similar levels of effectiveness and safety of DAA therapies in the pediatric population. Thus, an enhanced cascade of care, which should include the population under 18 years of age, can help achieve the WHO goal by focusing on elimination in the youngest populations. This review will present an overview of the natural history, clinical features, and management of HCV in children and adolescents.

One-Year Outcomes after Ledipasvir/Sofosbuvir Treatment of Chronic Hepatitis C in Teenagers with and without Significant Liver Fibrosis—A Case Series Report

“…In addition, little is known about the long-term outcomes and the influence of the antiviral treatment on liver fibrosis. Patients with confirmed liver fibrosis should be closely monitored even after effective antiviral treatment of CHC [ 21 ]. Interestingly, there is evidence that in adult patients, liver fibrosis may be to some extent reversed by DAA treatment [ 21 , 22 , 23 , 24 ].…”

“…Patients with confirmed liver fibrosis should be closely monitored even after effective antiviral treatment of CHC [ 21 ]. Interestingly, there is evidence that in adult patients, liver fibrosis may be to some extent reversed by DAA treatment [ 21 , 22 , 23 , 24 ]. Bachofner et al revealed a 32% reduction in the LSM after DAA treatment in 392 adult patients with CHC complicated by fibrosis [ 25 ].…”

Long-term Outcomes of Ledipasvir/sofosbuvir Treatment of Chronic Hepatitis C in Four Teenagers With Significant Liver Fibrosis

“…In addition, little is known about the long-term outcomes and the in uence of the antiviral treatment on liver brosis. Patients with con rmed liver brosis should be closely monitored even after effective antiviral treatment of CHC 21 . Interestingly, there is evidence that in adult patients, liver brosis may be to some extent reversed by DAA treatment [21][22][23][24] .…”

“…Patients with con rmed liver brosis should be closely monitored even after effective antiviral treatment of CHC 21 . Interestingly, there is evidence that in adult patients, liver brosis may be to some extent reversed by DAA treatment [21][22][23][24] . Bachofner et al revealed a 32% reduction in LSM after DAA treatment in 392 adult patients with CHC complicated by brosis 25 .…”

“…Bachofner et al revealed a 32% reduction in LSM after DAA treatment in 392 adult patients with CHC complicated by brosis 25 . However, patients with signi cant brosis are still at risk of HCC development even after achieving SVR 21,26 . Mogahed et al recently reported improvement in LSM in pediatric patients with CHC after treatment with DAA 10 .…”