NASPGHAN Practice Guidelines

Abstract

Hepatitis C virus (HCV) is an RNA virus that affects >180 million individuals worldwide with a high propensity for chronic infection. Children with HCV infection differ from adults in several ways including some modes of transmission, rates of clearance, progression of fibrosis, and the duration of potential chronic infection when acquired at birth. Since the discovery of HCV in 1989, there have been significant advances in the understanding of the virology and natural history of chronic HCV infection in children. In addition, there are now several treatment options for children with chronic hepatitis C infection and many new therapies on the horizon. As a consequence, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition brought together experts in pediatric hepatology to review the available data in children and provide clinicians with approaches to the diagnosis, management, and prevention of HCV infection in children and adolescents. The guideline details the epidemiology and natural history of HCV infection in children, the diagnostic workup, monitoring and treatment of disease, and provides an update on future treatment options and areas of research.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…Some experts prefer starting treatment earlier as there is better treatment response and tolerability of PEG‐IFN and ribavirin in children compared with adults 144, 145. This may be especially relevant for patients with HCV genotypes 2 and 3, for whom sustained virological response with PEG‐IFN and ribavirin over 24 weeks is much better than for genotype 1 (sustained virological response in HCV‐monoinfected children 89–93% 146, 147.…”

Hepatitis C virus infection in children and adolescents

“…In older children, the recommended testing sequence parallels adult guidelines and begins with an investigation for the presence of anti‐HCV. Current immunoassays for anti‐HCV are at least 97% sensitive and 99% specific4, 33, 34; importantly however, both false positive (patients with autoimmune disease, mononucleosis, pregnancy) and false negatives (patients with hypogammaglobulinemia or immunosuppressed patients) can occur 33. If the anti‐HCV is positive, HCV RNA quantification and genotype should be performed to confirm the infection.…”

“…Maternal antibody can persist in the child for over a year, consequently testing for anti‐HCV in infants is not informative during this period. The American Academy of Pediatrics' recommendations are to delay measurement of anti‐HCV antibody until after 18 months of age 4. HCV RNA testing can reliably indicate perinatal transmission; however, infants should be at least 2 months old for this test to be reliable 4, 36.…”

“…The American Academy of Pediatrics' recommendations are to delay measurement of anti‐HCV antibody until after 18 months of age 4. HCV RNA testing can reliably indicate perinatal transmission; however, infants should be at least 2 months old for this test to be reliable 4, 36. Retesting at 12 months should occur to confirm chronic HCV infection and to rule out the possibility of spontaneous seroconversion, defined as the absence of detectable HCV RNA on two occasions >6 months apart,37, 38 which occurs in 25%‐40% of infants infected via perinatal transmission 4, 39.…”

“…HCV infection across the pediatric age spectrum differs from infection acquired later in life in a variety of ways, including modes of transmission, rates of spontaneous clearance or progression of fibrosis, the potential duration of chronic infection when acquired at birth, and significantly, available treatment options 4. While several reviews have recently been published regarding aspects of HCV infection in adults,3, 5, 6 our goal is to present a practical overview of the epidemiology, diagnosis, clinical features, natural history, and management of HCV infection in children and adolescents.…”