Future Treatment May Be Best for Kids with Hepatitis C

The best time to treat children infected with the hepatitis C virus may be off in the future when newer, better drugs with fewer side effects are expected to be approved for pediatric populations, according to the authors of a recent article in Clinical Liver Disease.

Hepatitis C is a bloodborne virus that over time if left unchecked can severely damage the liver. But for children who are chronically infected, progression to advanced liver disease during their childhood years is uncommon, says lead author Christine Lee, MD.

A major milestone in the treatment of hepatitis C is the recent development of direct-acting antiviral (DAA) agents and combination drug regimens, Lee stated in the article. These developments are likely to similarly revolutionize treatment of the virus in children in the near future however clinical trials are still being conducted, she said.

In an online video interview, Lee (who is an attending physician at Boston Children’s hospital) spoke about how children acquire the virus, how it is diagnosed and suggested treatments. She said most children she sees who have been diagnosed don’t feel sick from the virus and are being seen as part of surveillance initiated by their pediatricians.

“They are otherwise feeling well but parents come in quite nervous and wanting to know more,” Lee explained.

When parents of an infected child initially come to see her, Lee said she spends the first several visits educating them about the virus and talking about how current regimens are not approved for children under 3 years old. Those who seek her help are typically young parents of very young children.

“It’s usually giving them a lot of reassurance and talking about the currently approved treatments starting from age 3,” she said.

Children who have the virus most often contracted it from their mother either before or at the time of birth. So far, doctors have not identified any way to lower the 5% rate of prenatal transmission. Peginterferon and ribavirin, older treatments known to cause serious side effects in many patients, are the only regimens that are currently approved for use in children and the patient must be 3 years of age or older.

The process of diagnosing a child with hepatitis C is similar to that of an adult and genotype testing that helps indicate appropriate therapy is recommended, according to Lee. While new DAA drugs have had great success rates in adults, none have yet received regulatory approval for use in children with hepatitis C, but that is expected to change.

“Because of the quickly progressing development and testing of DAA agents, we suggest deferring treatment for chronic hepatitis C in most children until interferon-free regimens are available for this population,” wrote Lee. “Deferring treatment for even several years is often appropriate because most pediatric patients have mild liver disease that progresses slowly.”

There are some exceptions when deferring treatment is not recommended. In children with compensated liver disease, regimens with peginterferon and ribavirin can be given in various doses and durations depending somewhat on the age and genotype of the patient, according to the article.

Looking to the future, Lee said that given anticipation that DAA agents will one day be approved for use in children, she can’t imagine that interferon regimens would be used on a large-scale basis 10 years from now.