- The European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has issued a position paper regarding the treatment of pediatric HCV.
Why this matters
- Ledipasvir/sofosbuvir (LDV/SOF) and sofosbuvir/ribavirin (SOF/RBV) are approved in the US/Europe for patients aged 12-17 years; peginterferon (PegIFN)+RBV is used in younger children.
- Systematic review/meta-analysis of studies involving PegIFN/RBV (11) or direct-acting antivirals (DAAs; 5).
- ESPGHAN Hepatology Committee members voted on each recommendation.
- Funding: None.
- In the absence of high-risk factors, treatment can generally be deferred when PegIFN/RBV is the only option.
- Interferon-free regimens are best for children aged >12 years weighing >35 kg; PegIFN/RBV is no longer recommended.
- Children aged >12 years weighing >35 kg:
- HCV-1/4: LDV/SOF for 12 weeks, extended to 24 weeks in treatment-experienced patients and those with compensated cirrhosis.
- HCV-2: SOF plus weight-based RBV for 12 weeks.
- HCV-3: SOF plus weight-based RBV for 24 weeks.
- Children aged <12 years:
- PegIFN/RBV is no longer recommended as a general treatment.
- Treatment initiation should be individualized based on HCV genotype, liver disease severity, adverse effects, likelihood of response, and comorbidities.
- Experienced treatment center is recommended.
- Possible off-label use of DAAs could be considered.
- Few DAA trials, all with very short follow-up.