Clinical practice guidelines for the management of children with mother‐to‐child transmitted hepatitis C virus infection

Abstract

Background: The first guidelines for care of pregnant women carrying the hepatitis C virus (HCV) and their infants were published in 2005 in Japan. Since then, evidence has gradually accumulated worldwide regarding the natural course and treatment of this condition and, especially in recent years, treatment for chronic hepatitis C in adult patients has made great progress. However, the clinical practice policy for children has not been standardized, and new clinical practice guidelines for children with mother-to-child (MTC) transmitted HCV infection have become necessary. Methods: In the development of the current guideline, we requested cooperation from The Japanese Society for Pediatric Infectious Diseases, The Japan Society of Hepatology, and the Japan Society of Obstetrics and Gynecology. The committee members were recommended and approved by each society to participate in developing the guidelines. The guideline was also created in accordance with the Minds Guide for Practice Guideline Development. The statements were prepared by consensus-building using the Delphi method, based on the comprehensively searched academic papers and guidelines. These articles were retrieved through searching the PubMed, Cochrane Library, and the Igaku Chuo Zasshi databases. Results: Eight clinical questions (CQs) with clinical statements were developed regarding etiology (CQs 1-3), diagnosis (CQs 4 and 5), and treatment (two CQs 6 and 7). In each statement, the consensus rate, evidence level, and recommendation level were determined. Conclusion: The guidelines will be helpful in the management of children with hepatitis C MTC transmission.

Current management of children with hepatitis C virus mother‐to‐child transmission

“…The guideline first states that, in pregnant women who are HCV carriers, elective cesarean delivery does not reduce the rate of mother‐to‐child transmission, and therefore it is recommended that elective cesarean delivery should not be performed to prevent mother‐to‐child transmission 4 . However, for HCV carrier mothers with a high viral load, the rate of mother‐to‐child transmission by mode of delivery in Japan should be explained, and the preferences of mothers and their families should be respected 4 . In addition, as breast‐feeding of a child born to an HCV carrier mother does not increase the rate of mother‐to‐child transmission, it is recommended that formula‐feeding to prevent mother‐to‐child transmission should not be given 4 …”

“…Remarkably, the latest generation of DAAs (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, and sofosbuvir/velpatasvir/voxilaprevir) have pan‐genotypic activity, thus simplifying treatment decisions 5 . In Japan, as a treatment of genotype 1 and 2 HCV in 12–17 year old pediatric patients, glecaprevir/pibrentasvir was officially approved on August 22, 2019 4 . Interferon‐based treatment regimens are no longer recommended as therapeutic options in adolescents and children with HCV, given the high toxicity and modest sustained virological response (SVR) rates 4,5 .…”

“…3 The JSPGHAN published the Japanese version of clinical practice guidelines for the management of children with mother-to-child transmitted HCV infection in 2020, and now the English version is published in this issue. 4 The guideline first states that, in pregnant women who are HCV carriers, elective cesarean delivery does not reduce the rate of motherto-child transmission, and therefore it is recommended that elective cesarean delivery should not be performed to prevent mother-to-child transmission. 4 However, for HCV carrier mothers with a high viral load, the rate of mother-to-child transmission by mode of delivery in Japan should be explained, and the preferences of mothers and their families should be respected.…”

“…4 However, for HCV carrier mothers with a high viral load, the rate of mother-to-child transmission by mode of delivery in Japan should be explained, and the preferences of mothers and their families should be respected. 4 In addition, as breast-feeding of a child born to an HCV carrier mother does not increase the rate of mother-to-child transmission, it is recommended that formula-feeding to prevent mother-to-child transmission should not be given. 4 Secondly, the introduction of direct-acting antivirals (DAAs) changed the HCV treatment paradigm.…”

“…4 In addition, as breast-feeding of a child born to an HCV carrier mother does not increase the rate of mother-to-child transmission, it is recommended that formula-feeding to prevent mother-to-child transmission should not be given. 4 Secondly, the introduction of direct-acting antivirals (DAAs) changed the HCV treatment paradigm. These regimens are oral, patient-friendly, have treatment schedules as short as 8 weeks, are highly effective, and have few side effects.…”