Hepatitis C virus infection in children and adolescents: a management update

Hepatitis C virus infection is an emerging problem for children and adolescents. Chronic HCV infection affects approximately 3.5–5 million children worldwide. Unaddressed HCV infection in children progresses to decompensated liver disease and hepatocellular carcinoma during adulthood. Early detection of HCV and the administration of appropriate antiviral therapy are required for the prevention of long-term morbidity associated with chronic HCV infection. The perinatal route is the most common source of childhood HCV infection. Anti-HCV positivity at or after 18 months of age necessitates an HCV-RNA assay after age 3 to recognize chronic HCV infection. Both anti-HCV and HCV-RNA positivity are the indications for antiviral therapy. At present, various combinations of oral, direct-acting antivirals (DAAs) have been approved for children above 3 years of age. Their efficacy is high. Apart from the effectiveness of DAA therapy, steps should be taken to screen pregnant women to prevent the transmission of viral infection from mother to child. To increase awareness about the mode of HCV spread, NAT-based tests in blood banks for better screening and making the DAAs available at a subsidized rate in the public sector are necessary to eradicate HCV infection.