Mari Paula Chaves, Gulati Reema, Fragassi Philip
Department of Pediatrics, MetroHealth Medical Center, Cleveland, OH, USA.
Adolesc Health Med Ther. 2021 May 7;12:45-53. doi: 10.2147/AHMT.S263864. eCollection 2021.
The prevalence of Hepatitis C virus infection (HCV), a leading cause of chronic liver disease worldwide, is rising in the United States (US) and other high-income countries, especially among youth and young adults. This surge in cases is closely associated with the opioid crisis and intravenous drug use (IVDU). However, its prevalence and impact on the adolescent population have not been thoroughly studied and therefore is poorly understood. The pediatric population tends to have milder liver disease and progression when compared to adults; however, there is a risk of developing liver cirrhosis, in addition to facing decreased quality of life and stigmatization from the disease. The recent approval of direct-acting antiviral (DAA) regimens for all HCV genotypes and age greater than 3 years has revolutionized its management. Therapy has shifted from the prolonged interferon-based regimens, to shorter duration, once daily oral pills that are highly effective, curative and with fewer side effects. Therapy is now indicated for all adolescents with hepatitis C virus infection, regardless of stage of liver disease, recent IVDU, or coinfection with HIV, therefore eliminating a lifetime risk of chronic liver disease, cirrhosis and hepatocarcinoma. Nonetheless, adolescents are rarely tested or treated for hepatitis C infection, and very few adolescents complete therapy. Implementation of point of care (POC) testing of high-risk youth at drug treatment centers or other juvenile facilities may be a good strategy to increase testing, diagnosis and therapy. This review article aims to educate pediatricians and other primary care providers to help decrease the existing knowledge gap on the subject.
丙型肝炎病毒感染（HCV）是全球慢性肝病的主要病因，在美国和其他高收入国家，其感染率正在上升，尤其是在青少年和青年成年人中。病例的激增与阿片类药物危机和静脉注射吸毒（IVDU）密切相关。然而，其在青少年人群中的患病率及其影响尚未得到充分研究，因此了解甚少。与成年人相比，儿科人群往往肝病较轻且病情进展较慢；然而，除了面临生活质量下降和疾病带来的污名化之外，还有发展为肝硬化的风险。最近，针对所有HCV基因型且年龄大于3岁的直接抗病毒（DAA）方案的批准彻底改变了其治疗方式。治疗已从基于干扰素的长期方案转变为疗程更短、每日一次的口服药片，这些药片高效、可治愈且副作用较少。现在，所有丙型肝炎病毒感染的青少年都有治疗指征，无论肝病阶段、近期是否静脉注射吸毒或是否合并感染HIV，从而消除了慢性肝病、肝硬化和肝癌的终身风险。尽管如此，青少年很少接受丙型肝炎感染检测或治疗，而且很少有青少年完成治疗。在药物治疗中心或其他青少年设施对高危青年进行即时检验（POC）检测可能是增加检测、诊断和治疗的一个好策略。这篇综述文章旨在教育儿科医生和其他初级保健提供者，以帮助缩小该主题上现有的知识差距。
