Management of Special Groups: Hepatitis C in Children

• HCV infection in children is relatively benign.
• The benefit of long-term treatment of HCV in children has not been established.

Although HCV infection in children shares some features of that in adults, it is clearly different in several aspects. Children tend to have milder disease and fewer comorbid conditions, and extrahepatic manifestations are less common. Therefore, justification for aggressive therapy is different for children. Moreover, given the benign outcome of HCV infection in children, treatment is not always indicated, although there has been some suggestion that pediatric HCV infection might lead to cirrhosis decades later.

Interferon has not been approved by the FDA for treating chronic HCV infection in children. No large controlled clinical trial has been reported, and the efficacy and safety of IFN for children have not been well established. However, one randomized controlled trial comparing IFN alfa-2b (at 5 million IU/m² body surface area) with no treatment did suggest that therapy is beneficial.¹²³ Of the 13 children in the treatment group, 6 (46%) achieved sustained biochemical and virologic responses; no virologic response was observed in any of the 13 patients in the nontreatment group. It is important that larger controlled trials be conducted to establish recommendations for the management of HCV infection in children. Because HCV infection is less prevalent among children, multicenter trials are warranted. Currently, at least two multicenter randomized clinical trials are under way to study the safety and efficacy of PEG-IFN alfa-2a and -2b in children.