Progress and Barriers Towards Elimination of Chronic Hepatitis C in Children

Abstract

Chronic hepatitis C (CHC) is a global health burden. Mother-to-child transmission (MTCT) accounts for most HCV infections in pediatric patients. Spontaneous viral clearance may occur in early childhood but is uncommon thereafter. Infection is usually asymptomatic during childhood, although without an effective treatment, vertically infected children may develop serious liver complications including cirrhosis and hepatocellular carcinoma in adulthood. Despite the lack of vaccine against hepatitis C and effective post-exposure methods of prevention of MTCT, treatment with direct-acting antiviral agents (DAAs) raised the prospect of eliminating HCV on a population level. Highly effective, well-tolerated, oral, and interferon-free regimens of short duration have revolutionized treatment of CHC. However, access to these therapies might be limited because of its high cost. In this review, we provide the current state of knowledge on the epidemiology, testing, monitoring and treating of HCV in children. We outline the remaining gaps in therapy and barriers to disease eradication.

Seroprevalence of hepatitis C virus infection in children: A systematic review and meta‐analysis

“…Even in Western Europe and the United States, data was scant, based on obsolete studies, or absent, and was insufficient to create regional prevalence estimates 2–4 . Unfortunately, the majority of global estimates of HCV prevalence, burden, morbidity and death are based on data from adults 1–26 …”

“…Estimates of paediatric prevalence are needed to aid in the scaling up of therapy and screening and testing approaches for this population. The prevalence of HCV in this unique community has not been adequately investigated 2–9 . In Western Europe, the prevalence is expected to be 1.5% to 3.5%, but barely 0.5% in the United Kingdom, with little information on the prevalence in low‐income countries 2–10 …”

“…The prevalence of HCV in this unique community has not been adequately investigated 2–9 . In Western Europe, the prevalence is expected to be 1.5% to 3.5%, but barely 0.5% in the United Kingdom, with little information on the prevalence in low‐income countries 2–10 …”

“…HCV infection raises the risk of morbidity and mortality, and it is the major cause of end‐stage liver disease, cirrhosis and liver cancer in people all over the world 18–23 . Despite the fact that HCV infection seldom causes morbidity in children, the majority of HCV‐infected children develop chronic HCV, putting them at risk for life‐threatening liver disease 9–26 …”

“…Furthermore, some research suggests that HCV has an impact on children's quality of life and behaviour, as cognitive function has been proven to be impaired, and families have reported greater levels of stress, both of which have a negative impact on family connections and well‐being 21–27 . There are few statistics on the prevalence of HCV in children at the moment 2–17 . The purpose of this study was to look at the global prevalence of HCV in children in order to contribute to the ultimate goal to completely eradicate HCV by 2030.…”