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.

Zussamenfassung

Chronische Hepatitis C (CHC) stellt eine globale Gesundheitsbelastung dar. Die Mutter-Kind-Übertragung (MTCT) ist für die meisten HCV-Infektionen bei pädiatrischen Patienten verantwortlich. Eine spontane Virusfreisetzung kann in der frühen Kindheit auftreten, ist danach aber selten. In der Regel verläuft die Infektion während der Kindheit asymptomatisch, obwohl unbehandelte vertikal infizierte Kinder schwere Leberkomplikationen wie Zirrhose und Leberzellkarzinom im Erwachsenenalter entwickeln können. Trotz des Fehlens eines Impfstoffs gegen Hepatitis C und wirksamer Methoden zur Prävention von MTCT nach der Exposition hat die Behandlung mit direkt wirkenden antiviralen Wirkstoffen (DAA) die Aussicht auf eine Eliminierung von HCV auf Bevölkerungsebene erhöht. Hochwirksame, gut verträgliche, orale und kurzzeitige interferonfreie Therapien haben die Behandlung von CHC revolutioniert. Der Zugang zu diesen Therapien könnte jedoch aufgrund der hohen Kosten begrenzt sein. In diesem Überblick stellen wir den aktuellen Stand des Wissens über Epidemiologie, Testung, Überwachung und Behandlung von HCV bei Kindern dar. Wir skizzieren die verbleibenden Therapielücken und Hindernisse bei der Ausrottung der Krankheit.

Key words

hepatitis C - HCV in children - direct-acting antivirals - DAA - Mother-to-child transmission

Schlüsselwörter

Hepatitis C - HCV bei Kindern - direkt wirkende antivirale Wirkstoffe - DAA - Mutter-Kind-Übertragung

Publication History

Article published online:
18 December 2020

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