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Honegger JR, Gowda C. Defer no more: advances in the treatment and prevention of chronic hepatitis C virus infection in children. Curr Opin Infect Dis 2022; 35:468-476. [PMID: 35852787 PMCID: PMC9474609 DOI: 10.1097/qco.0000000000000856] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Direct-acting antiviral (DAA) regimens targeting hepatitis C virus (HCV) are now approved for young children. This review examines recent DAA experience in children, current treatment recommendations and challenges, and potential treatment-as-prevention strategies. RECENT FINDINGS In 2021, the US FDA extended approval of two pan-genotypic DAA regimens, glecaprevir/pibrentasvir and sofosbuvir/velpatasvir, to children as young as age 3 years based on high success rates and reassuring safety profiles in registry trials. Similar performance has been replicated with real-world DAA use in thousands of adolescents and in limited reports of children with high-risk conditions, including cirrhosis, cancer, thalassemia and HIV-coinfection. Treatment without delay is now recommended in the USA for viremic children aged 3 years and up to prevent disease progression and future spread. To date, treatment expansion is limited by high rates of undiagnosed paediatric infection. Universal prenatal screening will aid identification of perinatally exposed newborns, but new strategies are needed to boost testing of exposed infants and at-risk adolescents. Postpartum treatment programmes can prevent subsequent vertical transmission but are hampered by low rates of linkage to care and treatment completion. These challenges may be avoided by DAA use in pregnancy, and this warrants continued study. SUMMARY Paediatric HCV is now readily curable. Substantial clinical and public health effort is required to ensure widespread uptake of this therapeutic breakthrough.
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Affiliation(s)
- Jonathan R. Honegger
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Center for Vaccines and Immunity, Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Charitha Gowda
- Division of Pediatric Infectious Diseases, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Partners For Kids, Nationwide Children’s Hospital, Columbus, Ohio, USA
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2
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Singh A, Jakhar N, Gera A, Mittal R, Mehndiratta S, Shalimar. Treatment of hepatitis C in a case of pediatric B-cell acute leukemia. J Glob Infect Dis 2022; 14:35-37. [PMID: 35418736 PMCID: PMC8996459 DOI: 10.4103/jgid.jgid_1_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/05/2021] [Accepted: 03/23/2021] [Indexed: 11/04/2022] Open
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3
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Mikulska M, Knelange N, Nicolini LA, Tridello G, Santarone S, Di Bartolomeo P, de la Camara R, Cuéllar C, Velardi A, Perruccio K, Ljungman P, Zaucha J, Piekarska A, Basak G, Karakulska-Prystupiuk E, Angelucci E, Ciceri F, Lupo-Stanghellini MT, Fouillard L, García-Cadenas I, Menconi M, Blau IW, Nassi L, Cesaro S, Styczynski J. Efficacy, safety and feasibility of treatment of chronic HCV infection with directly acting agents in hematopoietic stem cell transplant recipients - Study of infectious diseases working party of EBMT. J Infect 2021; 84:71-79. [PMID: 34757138 DOI: 10.1016/j.jinf.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Limited data is available on HCV directly acting agents (DAAs) in haematopoietic stem cell transplant (HSCT) recipients. This study aimed at reporting the characteristics, treatment practices and treatment efficacy in HSCT recipients with chronic HCV. METHODS Prospective observational study from EBMT Infectious Diseases Working Party (IDWP). Patients with chronic HCV infection were included. RESULTS Between 12/2015 and 07/2018, 45 patients were included: male in 53%; median age 49 years (range, 8-75); acute leukaemia in 48.9%, lymphoma in 17.7%, non-malignant disorders in 22.3%; allogeneic HSCT in 84%; 77.8% no immunosuppressive treatment. Genotypes 1, 2, 3 and 4 were detected in 54.5%, 20.5%, 13.6% and 11.4%, respectively; advanced fibrosis in 40%, including cirrhosis in 11.4%. Overall, 37 (82.2%) patients received DAAs, at a median of 8.4 years after HSCT (16.2% within 6 months from HSCT). Sofosbuvir-based treatment was given to 62.2%. Thirty-five patients completed planned treatment course, with sustained virological response (SVR) of 89.1%, and 94.3% (33/35) in those who completed the treatment. Side effects possibly related to DAAs were reported in 5 (14%) and did not require treatment discontinuation. CONCLUSIONS DAAs treatment was effective, safe and feasible in this cohort of mainly allogeneic HSCT recipients with mild/moderate liver damage.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genova 16132, Italy.
| | - Nina Knelange
- Department Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, the Netherlands
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gloria Tridello
- Paediatric Haematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stella Santarone
- Dipartimento Oncologia Ematologia, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | - Paolo Di Bartolomeo
- Dipartimento Oncologia Ematologia, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | | | - Clara Cuéllar
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | - Andrea Velardi
- Department of Medicine, Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy
| | - Katia Perruccio
- Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Per Ljungman
- Department for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan Zaucha
- University Hospital Department of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Piekarska
- University Hospital Department of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland; Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Karakulska-Prystupiuk
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Emanuele Angelucci
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | | | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - Mariacristina Menconi
- Unità Operativa Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Pisa, Pisa, Italy
| | | | - Luca Nassi
- Division of Hematology, Department of Translational Medicine, Universita' del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, Italy
| | - Simone Cesaro
- Paediatric Haematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, University Hospital, Collegium Medicum UMK Torun, Bydgoszcz, Poland
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4
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Nicastro E, Norsa L, Di Giorgio A, Indolfi G, D'Antiga L. Breakthroughs and challenges in the management of pediatric viral hepatitis. World J Gastroenterol 2021; 27:2474-2494. [PMID: 34092970 PMCID: PMC8160618 DOI: 10.3748/wjg.v27.i20.2474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/04/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic infections by hepatitis B virus (HBV) and hepatitis C virus (HCV) major causes of advanced liver disease and mortality worldwide. Although regarded as benign infections in children, their persistence through adulthood is undoubtedly of concern. Recent advances in HCV treatment have restored the visibility of these conditions and raised expectations for HBV treatment, which is currently far from being curative. Herein we describe direct-acting antivirals available for pediatric HCV (sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) and their real-world use. A critical review of the HBV pediatric classification is provided. Anti-HBV investigational compounds are reviewed in light of the pathophysiology in the pediatric population, including capsid assembly modulators, antigen secretion inhibitors, silencing RNAs, and immune modifiers. Recommendations for screening and management of immunosuppressed children or those with other risk factors or comorbidities are also summarized.
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Affiliation(s)
- Emanuele Nicastro
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Lorenzo Norsa
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Angelo Di Giorgio
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
| | - Giuseppe Indolfi
- Department of Neurofarba, Meyer Children's University Hospital of Florence, Florence 50137, Italy
| | - Lorenzo D'Antiga
- Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
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5
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Grasso AG, Sonzogni A, Zanon D, Maestro A, Loiacono S, Maximova N. Treatment of hepatitis C in two paediatric patients using sofosbuvir during haematopoietic stem cell transplantation. Antivir Ther 2020; 24:603-607. [PMID: 31509110 DOI: 10.3851/imp3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
We report the first two paediatric cases of sofosbuvir treatment during high-intensity myeloablative conditioning and engraftment phases of haematopoietic stem cell transplantation. These reports highlight the safety of sofosbuvir during all phases of transplantation and the lack of interaction between sofosbuvir and alkylating or immunosuppressive agents.
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Affiliation(s)
- Antonio G Grasso
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Aurelio Sonzogni
- Department of Pathology, Ospedale Beato Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Alessandra Maestro
- Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Stefano Loiacono
- Pharmacy and Clinical Pharmacology Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Natalia Maximova
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
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6
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Jaiswal SR, Bhakuni P, Soni M, Gupta M, Thatai A, Chakrabarti S. Safety and efficacy of Sofosbuvir and Velpatasvir in children with active hepatitis C virus infection undergoing haploidentical transplantation. Transpl Infect Dis 2020; 23:e13490. [DOI: 10.1111/tid.13490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/16/2020] [Accepted: 10/04/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Sarita Rani Jaiswal
- Cellular Therapy and Immunology Manashi Chakrabarti Foundation Kolkata India
- Department of Blood and Marrow Transplantation & Hematology Dharamshila Narayana Super‐Speciality Hospital and Research Centre New Delhi India
| | - Prakash Bhakuni
- Cellular Therapy and Immunology Manashi Chakrabarti Foundation Kolkata India
- Department of Blood and Marrow Transplantation & Hematology Dharamshila Narayana Super‐Speciality Hospital and Research Centre New Delhi India
| | - Mayank Soni
- Department of Blood and Marrow Transplantation & Hematology Dharamshila Narayana Super‐Speciality Hospital and Research Centre New Delhi India
| | - Mahesh Gupta
- Department of Gastroenterology Dharamshila Narayana Super‐Speciality Hospital New Delhi India
| | - Atul Thatai
- Molecular Diagnostics and R&D Dr LalPathLabs Ltd New Delhi India
| | - Suparno Chakrabarti
- Cellular Therapy and Immunology Manashi Chakrabarti Foundation Kolkata India
- Department of Blood and Marrow Transplantation & Hematology Dharamshila Narayana Super‐Speciality Hospital and Research Centre New Delhi India
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7
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Ramgopal A, Lauko A, Rotz S, Hanna R. Safety of allogeneic hematopoietic stem cell transplantation in beta-thalassemia patients with chronic hepatitis C infections treated at a pediatric center. Pediatr Transplant 2019; 23:e13520. [PMID: 31209983 DOI: 10.1111/petr.13520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 12/11/2022]
Abstract
The outcome of allogeneic HCT in patients previously infected with HCV is a widely debated topic and rarely reported in the pediatric and young adult age group given the small population of affected patients. New medications directly targeting HCV have induced virologic cures for over 90% of patients, and their use in the pretransplant setting may improve outcomes for patients infected with HCV. We describe two patients with transfusion-dependent beta-thalassemia major who underwent matched sibling donor bone marrow transplantation, one with a myeloablative regimen and one with a reduced-intensity conditioning regimen. Allogeneic HCT appears feasible in patients with HCV infection that clear viremia prior to conditioning therapy and with a reduced-intensity conditioning regimen. Further investigation is warranted to better define transplant risks in this population.
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Affiliation(s)
- Archana Ramgopal
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Adam Lauko
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Seth Rotz
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Rabi Hanna
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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8
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Rauwolf K, Herbrüggen H, Zöllner S, Thorer H, Makarova O, Kaiser T, Pettke A, Rossig C, Burkhardt B, Groll AH. Durable control of hepatitis C through interferon-free antiviral combination therapy immediately prior to allogeneic haematopoietic stem cell transplantation. J Viral Hepat 2019; 26:454-458. [PMID: 30516856 DOI: 10.1111/jvh.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 12/18/2022]
Abstract
Chronic hepatitis C virus (HCV) infection carries increased risks for morbidity and mortality in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) but has become curable through the advent of directly acting antiviral compounds. Current guidelines of the American Society for Blood and Marrow Transplantation (ASBMT) recommend that HCV-infected HSCT candidates preferably start and complete therapy prior to transplant. However, this is often not feasible due to time constraints or treatment-limiting comorbidities, conditions and treatments. For these reasons, data on the safety of antiviral treatment, its efficacy to achieve durable eradication of the virus until full immune recovery, and late effects of former HCV infection in patients receiving HSCT are unknown. Here, we report the course of two paediatric patients with chronic HCV infection who received a full course of directly acting antivirals prior to allogeneic HSCT and achieved and maintained viral eradication throughout transplantation until complete immune recovery.
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Affiliation(s)
- Kerstin Rauwolf
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Heidi Herbrüggen
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Stefan Zöllner
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Heike Thorer
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Olga Makarova
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Thomas Kaiser
- Department of General Pediatrics, University Children's Hospital Münster, Münster, Germany
| | - Aleksandra Pettke
- Department of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Birgit Burkhardt
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
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9
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Noroozi-aghideh A, Kheirandish M. Human cord blood-derived viral pathogens as the potential threats to the hematopoietic stem cell transplantation safety: A mini review. World J Stem Cells 2019; 11:73-83. [PMID: 30842806 PMCID: PMC6397803 DOI: 10.4252/wjsc.v11.i2.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/14/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
Umbilical cord blood (UCB) is a valuable source of hematopoietic stem cells (HSCs) and potential alternative for bone marrow transplantation for patients who lack human leukocyte antigen (HLA)-matched donors. The main practical advantages of UCB over other HSC sources are the immediate availability, lower incidence of graft-versus-host disease, minimal risk to the donor, and lower requirement for HLA compatibility. However, the use of UCB is limited by delayed engraftment and poor immune reconstitution, leading to a high rate of infection-related mortality. Therefore, severe infectious complications, especially due to viral pathogens remain the leading cause of morbidity and mortality during the post-UCB transplantation (UCBT) period. In this context, careful screening and excluding the viral-contaminated UCB units might be an effective policy to reduce the rate of UCBT-related infection and mortality. Taken together, complete prevention of the transmission of donor-derived viral pathogens in stem cell transplantation is not possible. However, having the knowledge of the transmission route and prevalence of viruses will improve the safety of transplantation. To the best of our knowledge, there are few studies that focused on the risk of virus transmission through the UCB transplant compared to other HSC sources. This review summarizes the general aspects concerning the prevalence, characteristics, and risk factors of viral infections with a focus on the impact of viral pathogens on cord blood transplantation safety.
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Affiliation(s)
- Ali Noroozi-aghideh
- Department of Hematology, Faculty of Paramedicine, Aja University of Medical Sciences, Tehran 14665-1157, Iran
| | - Maryam Kheirandish
- Immunology Department, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine (IBTO), Tehran 14665-1157, Iran
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10
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Efficacy and Safety of Direct Acting Antiviral Therapy for Chronic Hepatitis C in Thalassemic Children. J Pediatr Hematol Oncol 2018; 40:511-514. [PMID: 29771862 DOI: 10.1097/mph.0000000000001217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES There is limited data on the efficacy and safety of directly acting antiviral therapy (DAA) for chronic hepatitis C in pediatric population. The aim was to assess the efficacy and safety of DAA in chronic hepatitis C β-thalassemic major pediatric patients. METHODS Prospective study was conducted from September 2015 to January 2017. All β-thalassemic major chronic hepatitis C pediatric patients with age between 5 and 14 years were included in this study. Data related to demography, laboratory parameters, hepatitis C viral load, genotype and outcome of antiviral therapy was analyzed. DAA was planned according to EASL guidelines 2015 for chronic hepatitis C therapy in adults. OBSERVATIONS Fourteen β-thalassemic major patients (median age was 9.5 y, 12 male) were studied. All patients were of genotype 3, received DAA (sofosbuvir 400 mg+daclatasvir 80 mg) for 12 weeks. The median viral load was 2.5×10 IU/mL. End of treatment response and sustained virological response at 12 weeks was achieved in all the patients. Serum alanine aminotransferase, aspartate aminotransferase, ferritin, and albumin significantly reduced after DAA. CONCLUSIONS DAA in adult dosage are safe and effective for treatment of chronic hepatitis C (genotype 3) in pediatric β-thalassemic major population.
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11
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Ahmed QS, Fadoo Z, Sadiq K, Altaf S. Hepatitis C at presentation in a newly diagnosed infant with B Acute Lymphoblastic Leukemia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2017.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Huysentruyt K, Stephenne X, Varma S, Scheers I, Leclercq G, Smets F, Sokal EM. Sofosbuvir/ledipasvir and ribavirin tolerability and efficacy in pediatric liver transplant recipients. Liver Transpl 2017; 23:552-553. [PMID: 28006874 DOI: 10.1002/lt.24692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/18/2016] [Accepted: 12/05/2016] [Indexed: 12/08/2022]
Affiliation(s)
- Koen Huysentruyt
- Services des Gastroentérologie et Hépatologie, Pédiatrique, Belgium
| | - Xavier Stephenne
- Services des Gastroentérologie et Hépatologie, Pédiatrique, Belgium
| | - Sharat Varma
- Services des Gastroentérologie et Hépatologie, Pédiatrique, Belgium
| | - Isabelle Scheers
- Services des Gastroentérologie et Hépatologie, Pédiatrique, Belgium
| | - Gisèle Leclercq
- Pharmacie hospitalière Cliniques Universitaires St Luc Université Catholique de Louvain Brussels, Belgium
| | - Françoise Smets
- Services des Gastroentérologie et Hépatologie, Pédiatrique, Belgium
| | - Etienne M Sokal
- Services des Gastroentérologie et Hépatologie, Pédiatrique, Belgium
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13
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Yang CHT, Yoo ER, Ahmed A. The Role of Direct-acting Antivirals in the Treatment of Children with Chronic Hepatitis C. J Clin Transl Hepatol 2017; 5:59-66. [PMID: 28507928 PMCID: PMC5411358 DOI: 10.14218/jcth.2016.00053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/13/2016] [Accepted: 01/05/2017] [Indexed: 12/13/2022] Open
Abstract
In the United States, chronic infection with the hepatitis C virus (HCV) affects an estimated 0.1-2% of the pediatric population, who are consequently at risk for major complications, including cirrhosis, hepatocellular carcinoma, and death. The current standard of treatment for chronic hepatitis C (CHC) in children is pegylated-interferon-alpha (PEG-IFN) in combination with ribavirin. PEG-IFN/ribavirin therapy is approved for children ages 3 and older; however, it is often held from use until adulthood because of its extensive list of potential side effects and high likelihood of causing adverse symptoms. While CHC is usually indolent in children and adolescents, immediately treating and curbing the spread of HCV before adulthood is important, as there can be transmission to other individuals via sexual activity and infected females can later vertically transmit the infection during pregnancy, the latter representing the most common means of transmission for children in the United States. The recent development of direct-acting antivirals has shown promising results in clinical trials for use in children and has dramatically increased the rates of sustained virological response in adults while improving side effect profiles as compared to interferon-based treatments. Given the usually indolent course of CHC in children, significant side effects of the currently-approved PEG-IFN/ribavirin therapy, and likely availability of all-oral interferon-free regimens for children within a few years, deferring treatment in clinically-stable children with CHC in anticipation of upcoming superior treatment modalities may be justified.
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Affiliation(s)
- Christine Hong Ting Yang
- Division of Pediatric Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric R. Yoo
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
- *Correspondence to: Aijaz Ahmed, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road, Suite #210, Stanford, CA 94304, USA. Tel: +1-650-498-5691, Fax: +1-650-498-5692, E-mail:
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