Yang Christine Hong Ting, Yoo Eric R, Ahmed Aijaz
Division of Pediatric Gastroenterology, Stanford University School of Medicine, Stanford, CA, USA.
Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA.
J Clin Transl Hepatol. 2017 Mar 28;5(1):59-66. doi: 10.14218/JCTH.2016.00053. Epub 2017 Feb 7.
In the United States, chronic infection with the hepatitis C virus (HCV) affects an estimated 0.1-2% of the pediatric population, who are consequently at risk for major complications, including cirrhosis, hepatocellular carcinoma, and death. The current standard of treatment for chronic hepatitis C (CHC) in children is pegylated-interferon-alpha (PEG-IFN) in combination with ribavirin. PEG-IFN/ribavirin therapy is approved for children ages 3 and older; however, it is often held from use until adulthood because of its extensive list of potential side effects and high likelihood of causing adverse symptoms. While CHC is usually indolent in children and adolescents, immediately treating and curbing the spread of HCV before adulthood is important, as there can be transmission to other individuals via sexual activity and infected females can later vertically transmit the infection during pregnancy, the latter representing the most common means of transmission for children in the United States. The recent development of direct-acting antivirals has shown promising results in clinical trials for use in children and has dramatically increased the rates of sustained virological response in adults while improving side effect profiles as compared to interferon-based treatments. Given the usually indolent course of CHC in children, significant side effects of the currently-approved PEG-IFN/ribavirin therapy, and likely availability of all-oral interferon-free regimens for children within a few years, deferring treatment in clinically-stable children with CHC in anticipation of upcoming superior treatment modalities may be justified.
在美国，丙型肝炎病毒（HCV）慢性感染估计影响0.1%-2%的儿童人群，这些儿童因此面临包括肝硬化、肝细胞癌和死亡在内的主要并发症风险。儿童慢性丙型肝炎（CHC）的当前治疗标准是聚乙二醇化干扰素-α（PEG-IFN）联合利巴韦林。PEG-IFN/利巴韦林疗法已被批准用于3岁及以上儿童；然而，由于其潜在副作用众多且很可能引发不良症状，通常要等到成年后才使用。虽然CHC在儿童和青少年中通常进展缓慢，但在成年前立即治疗并遏制HCV传播很重要，因为HCV可通过性行为传播给其他人，且受感染女性在怀孕期间可能会垂直传播感染，后者是美国儿童最常见的传播方式。直接作用抗病毒药物的最新进展在儿童临床试验中显示出了有前景的结果，并且与基于干扰素的治疗相比，显著提高了成人的持续病毒学应答率，同时改善了副作用情况。鉴于CHC在儿童中通常进展缓慢、目前批准的PEG-IFN/利巴韦林疗法有明显副作用，以及未来几年可能会有适用于儿童的全口服无干扰素治疗方案，对于临床稳定的CHC儿童，推迟治疗以期待即将出现的更优治疗方式可能是合理的。
