Summary: HCV in Children

Testing

Recommendations for HCV Testing of Perinatally Exposed Children and Siblings of HCV-Infected Children

RECOMMENDED RATING
All children born to HCV-infected women should be tested for HCV infection. Testing is recommended using an antibody-based test at or after 18 months of age. I, A
Testing with an HCV-RNA assay can be considered in the first year of life, but the optimal timing of such a test is unknown. IIa, C
Repetitive testing by HCV RNA is not recommended. III, A
Children who are anti-HCV positive after 18 months of age should be tested with an HCV-RNA assay after age 3 to confirm chronic hepatitis C infection. I, A
The siblings of children with vertically-acquired chronic HCV should be tested for HCV infection, if born from the same mother. I, C

 

Transmission and Prevention

Recommendations for Counseling Parents Regarding Transmission and Prevention in HCV-Infected Children

RECOMMENDED RATING
Parents should be informed that hepatitis C is not transmitted by casual contact and, as such, HCV-infected children do not pose a risk to other children and can participate in school, sports, and athletic activities, and engage in all other regular childhood activities without restrictions. I, B
Parents should be informed that universal precautions should be followed at school and in the home of children with HCV infection. Educate families and children about the risk and routes of HCV transmission, and the techniques for avoiding blood exposure, such as avoiding the sharing of toothbrushes, razors, and nail clippers, and the use of gloves and dilute bleach to clean up blood. I, B

 

 

Monitoring and Medical Management

Recommendations for Monitoring and Medical Management of HCV-Infected Children

RECOMMENDED RATING
Routine liver biochemistries at initial diagnosis and at least annually thereafter are recommended to assess for disease progression. I, C
Appropriate vaccinations are recommended for HCV-infected children not immune to hepatitis B virus and/or hepatitis A virus to prevent these infections. I, C
Disease severity assessment via routine laboratory testing and physical examination, as well as use of evolving noninvasive modalities (ie, elastography, imaging, or serum fibrosis markers) is recommended for all children with chronic HCV. I, B
Children with cirrhosis should undergo hepatocellular carcinoma (HCC) surveillance and endoscopic surveillance for varices per standard recommendations. I, B
Hepatotoxic drugs should be used with caution in children with chronic HCV after assessment of potential risk versus benefit of treatment. Use of corticosteroids, cytotoxic chemotherapy, or therapeutic doses of acetaminophen are not contraindicated in children with chronic HCV. II, C
Solid organ transplantation and bone marrow transplantation are not contraindicated in children with chronic HCV. II, C
Anticipatory guidance about the potential risks of ethanol for progression of liver disease is recommended for children with HCV and their families. Abstinence from alcohol and interventions to facilitate cessation of alcohol consumption, when appropriate, are advised for all persons with HCV infection. I, C

 

 

Treatment

Recommendations for Whom and When to Treat Among HCV-Infected Children

RECOMMENDED RATING
If direct-acting antiviral (DAA) regimens are available for a child’s age group, treatment is recommended for all HCV-infected children older than 3 years as they will benefit from antiviral therapy, independent of disease severity. I, B
Treatment of children aged 3 to 11 years with chronic hepatitis C should be deferred until interferon-free regimens are available. II, C
The presence of extrahepatic manifestations—such as cryoglobulinemia, rashes, and glomerulonephritis—as well as advanced fibrosis should lead to early antiviral therapy to minimize future morbidity and mortality. I, C

 

Recommended regimens listed by evidence level and alphabetically for:

Adolescents ≥12 Years Old or Weighing ≥35 kg, Without Cirrhosis or With Compensated Cirrhosis

RECOMMENDED DURATION RATING
Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) for patients with genotype 1 who are treatment-naive without cirrhosis or with compensated cirrhosisa, or treatment-experiencedb without cirrhosis 12 weeks I, B
Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) for patients with genotype 1 who are treatment-experiencedb with compensated cirrhosisa 24 weeks I, B
Daily sofosbuvir (400 mg) plus weight-based ribavirinc for patients with genotype 2 who are treatment-naive or treatment-experiencedb without cirrhosis or with compensated cirrhosisa 12 weeks I, B
Daily sofosbuvir (400 mg) plus weight-based ribavirinc for patients with genotype 3 who are treatment-naive or treatment-experiencedb without cirrhosis or with compensated cirrhosisa 24 weeks I, B
Daily fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) for patients with genotype 4, 5, or 6 who are treatment-naive or treatment-experiencedb without cirrhosis or with compensated cirrhosisa 12 weeks I, B
a Child-Pugh A
b Patients who have failed an interferon-based regimen, with or without ribavirin
c See ribavirin dosing table for recommended weight-based dosages.

 

Last update: 
May 24, 2018
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