5 Qs on Managing Hepatitis C in the Young

At what age can hepatitis C virus (HCV) RNA testing begin? Which pediatric patients are at greatest risk for HCV? Test your knowledge of diagnosis and treatment of HCV infection in children and teens with this month’s HCV quiz below.

Question 1. 

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Answer: B. 12-19 year olds. While the prevalence of HCV is higher in adults, as many as 5 million children worldwide have active HCV infection, one recent analysis suggests. In the US, an estimated 0.2% of children aged 6 to 11 years have chronic HCV infection, accounting for 31 000 cases; among adolescents (aged 12 to 19 years) 0.4%, or 101 000, are chronically infected with HCV, as reported in Annals of Internal Medicine. Estimates on children younger than age 6 were not available from this analysis, which was based on interviews and serum samples from participants aged ≥ 6 years.

Question 2. 

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Answer: A. Yes, if the mother is HCV-infected. Whether HCV RNA testing is warranted in the first year of life is the subject of substantial debate. Those opposed say it won’t obviate the need for definitive, antibody-based testing at 18 months of age or later, as is recommended in guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA). Moreover, if the infant is positive, treatment may be suboptimal, because there are currently no FDA-approved drugs for that age range, and because it may be appropriate to allow time for potential spontaneous clearance. However, testing could increase the detection rate for infection among infants; if the result is negative, it’s fairly clear evidence that there’s no infection, and if it’s positive, that will help pinpoint HCV cases early. The bottom line? Early HCV RNA testing may help identify infected infants and retain them in care; thus, the AASLD/IDSA guidelines state that HCV-RNA assay testing can be considered in the first year of life.

Question 3. 

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Answer: C. Ledipasvir/sofosbuvir. Sofosbuvir and ledipasvir/sofosbuvir were the first direct-acting antiviral drug regimens to be approved for treatment of pediatric patients. Both were previously FDA-approved in adults and are now approved in children aged 12 to 17 years, weighing at least 35 kg, without cirrhosis or with mild cirrhosis. The approvals provided pediatric treatment options for HCV genotypes 1-6: ledipasvir/sofosbuvir‎ is indicated for genotypes 1, 4, 5 or 6, while sofosbuvir (in combination with ribavirin) is indicated for genotypes 2 or 3 in pediatric patients meeting the weight and cirrhosis criteria.

Question 4. 

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Answer: E. None of the above. Solid organ and bone marrow transplantation are not contraindicated in children with chronic HCV infection, according to HCV guidelines. For children undergoing organ transplants or cytotoxic chemotherapy, there have been no reported icteric flares of HCV, as have been reported in children with chronic hepatitis B virus.

Question 5.

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Answer: A. The boy should not share toothbrushes or nail clippers with siblings. HCV-infected children may face discrimination and stigmatization at school or in childcare due to poor public understanding of HCV infection. Parents can be told that, since the virus is not transmitted through casual contact, infected children can be encouraged to participate in sports and other normal childhood activities with no restrictions. Families should not be forced to disclose the HCV infection status of a child, according to HCV guidelines. By contrast, families and children should be educated about techniques to minimize risk of HCV transmission, such as not sharing toothbrushes, nail clippers, and razors.