Treatment of Hepatitis C in children

OR: Odds ratio; PEDS-C: PEG-interferon with or without ribavirin in children with chronic hepatitis C trial; SD: Standard deviation.

Table 2.  Efficacy of combined treatment in children.

Study	Treatment schedule	Children (n)	SVR overall (%)	SVR genotype 1	SVR genotype 2&3	SVR parenteral	SVR vertical	SVR		Ref.
								Age <12 years	Age >12 years
Wirth et al. (2002)	IFN-α-2b 3–5 MU/m2 three-times weekly + RBV 15 mg/kg/day	41	61	18/34 (52.9%)	7/7 (100%)	9/16 (56%)	14/21 (66%)			[51]
Gonzalez-Peralta et al. (2005)	IFN-α-2b 3 MU/m2 three-times weekly + RBV 15 mg/kg/day	118	46	33/92 (36%)	21/25 (84%)			43/75 (57%)	11/43 (26%)	[52]
Wirth et al. (2005)	PEG- IFN-α-2b 1.5 µg/kg/week + RBV 15 mg/kg/day	61	59	22/46 (47.8%)	13/13 (100%)	19/27 (70.4%)	12/25 (48%)			[62]
Jara et al. (2008)	IFN-α-2b 1 µg/kg/week + RBV 15 mg/kg/day	30	50	12/26 (46%)	3/3 (100%)	7/9 (78%)	8/21 (38%)	9/20 (45%)	6/10 (60%)	[61]
P02538 study (2008)	IFN-α-2b 60 µg/kg/week + RBV 15 mg/kg/day	107	64	53%	93%					[58]
PEDS-C trial (2008)	IFN-α-2a 180 µg/1.73 m2/week + RBV 15 mg/kg/day	55	53	47%	Non-1: 80%					[60]

PEDS-C: PEG-interferon with or without ribavirin in children with chronic hepatitis C trial; RBV: Ribavirin; SVR: Sustained virologic response.

AE: Adverse event; RBV: Ribavirin.

Authors and Disclosures

Paloma Jara^†
Servicio de Hepatología, Hospital Infantil Universitario La Paz, Paseo Castellana 261, 28046 Madrid, Spain. Tel.: +34 917 277 065 Fax: +34 917 277 543 pjara.hulp@salud.madrid.org

Loreto Hierro
Hepatology Service, Hospital Infantil Universitario La Paz, Madrid, Spain

^†Author for correspondence
Servicio de Hepatología, Hospital Infantil Universitario La Paz, Paseo Castellana 261, 28046 Madrid, Spain. Tel.: +34 917 277 065 Fax: +34 917 277 543 pjara.hulp@salud.madrid.org

Sidebar

Key Issues

• A total of 80% of children develop a chronic infection after mother-to-child transmission. The diagnosis is established in those who remain hepatitis C virus RNA-positive at 3 years of age.

• The main characteristic of chronic hepatitis C is the persistence of disease over time, with slow progression of fibrosis.

• Progression to decompensated liver disease is observed in 1.7% of pediatric patients, occurring as soon as 2 years of age, although affected patients are usually older than 10 years.

• Starting therapy in children who are usually asymptomatic and rarely develop severe liver damage is controversial, given the potential adverse effects of current drugs.

• Treatment is justified, since it allows definitive resolution in an important subgroup of patients.

• Lack of treatment during childhood may delay therapy for a long time, especially considering the poor follow-up rates in adolescents and young adults.

• Combined PEG-IFN-α and ribavirin is the currently recommended treatment for children.

• Treatment achieves clearance of infection in 50% of genotype 1 patients and more than 90% of genotype 2 or 3 patients. Response in genotype 1 patients is positively influenced by baseline viral load <6 × 10⁵IU/ml (72% are responders).

• Early response (a viral load decrease > 2 log U) at on-treatment week 12 identifies those patients with genotype 1 who will permanently respond to therapy. Treatment is stopped if this early response is not achieved, thus avoiding unnecessary side effects.

• Flu-like symptoms and mild reduction in hemoglobin values are the most frequent side effects of therapy. Thyroid abnormalities and growth impairment during therapy, sometimes leading to permanent effects, are the main concerns when treating children.