Hepatitis C virus infection in children: How do we prevent it and how do we treat it?

Abstract

Hepatitis C virus (HCV) infection is an important contributor to the worldwide burden of liver-related morbidity and mortality. Mother-to-child transmission of HCV ranges from 6 to 11% in different populations globally, but accurate estimates on the burden of pediatric HCV infection are limited because screening approaches are not consistent. Areas covered: The advent of new direct-acting antiviral agents that achieve very high rates of sustained virologic response (representing virologic cure) with short (i.e. 8-12 weeks) regimens has revolutionized the field of HCV treatment and led to the development of global elimination goals for HCV transmission and mortality. However, information on their safety during pregnancy and efficacy in preventing mother-to-child transmission is lacking. Currently, there are no approved treatment regimens with these antiviral agents for children younger than 12 years of age. Expert commentary: If these agents are shown to be safe during pregnancy and effective in preventing transmission to the infant, screening of pregnant women and antenatal treatment of those infected, could pave the way for eliminating pediatric HCV infection- particularly as these drugs become less costly and more accessible. Treatment of infected children when indicated, along with universal safe health care practices, can further pediatric HCV elimination.

Ledipasvir‐Sofosbuvir for 12 Weeks in Children 3 to <6 Years Old With Chronic Hepatitis C

“…Worldwide, an estimated 71 million people are chronically infected with hepatitis C virus (HCV), of which an estimated 2.1‐5.0 million are children aged ≤15 years . In children, the primary route of HCV infection is perinatal transmission .…”

“…The rate of perinatal transmission of HCV infection is approximately 5%, although rates are higher in the presence of inadequately controlled human immunodeficiency virus (HIV) coinfection or high HCV‐RNA viral loads (>6 log IU/mL) . Chronic hepatitis C (CHC) likely affects at least 1% of pregnant women globally, although prevalence data at the regional level are incomplete and inconsistent . High rates exceeding 6% have been reported in certain hyperendemic regions of countries such as Egypt .…”

“…W orldwide, an estimated 71 million people are chronically infected with hepatitis C virus (HCV), of which an estimated 2.1-5.0 million are children aged ≤15 years. (1)(2)(3) In children, the primary route of HCV infection is perinatal transmission. (4) The rate of perinatal transmission of HCV infection is approximately 5%, although rates are higher in the presence of inadequately controlled human immunodeficiency virus (HIV) coinfection or high HCV-RNA viral loads (>6 log IU/mL).…”

Sofosbuvir and Ribavirin Therapy for Children Aged 3 to <12 Years With Hepatitis C Virus Genotype 2 or 3 Infection

“…Worldwide, it is estimated that 2.1 to 5 million children under 15 years of age have chronic hepatitis C virus (HCV) infection . In children, chronic HCV infection is often asymptomatic or with mild, nonspecific symptoms.…”

“…W orldwide, it is estimated that 2.1 to 5 million children under 15 years of age have chronic hepatitis C virus (HCV) infection. (1,2) In children, chronic HCV infection is often asymptomatic or with mild, nonspecific symptoms. However, progression to significant fibrosis can occur, (3) and cases of cirrhosis, (4)(5)(6) hepatocellular carcinoma, (7,8) and end-stage liver disease requiring liver Abbreviations: AUC, area under the curve; BMI, body mass index; CI, confidence interval; GT, genotype; HCV, hepatitis C virus; INR, international normalized ratio of prothrombin time; NI, nucleotide inhibitor; NS5B, nonstructural protein 5B; PK, pharmacokinetic; R AS, resistance-associated substitution; RBV, ribavirin; SOF, sofosbuvir; SVR, sustained virological response.…”