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World J Gastroenterol. Jan 14, 2012; 18(2): 99-104
Published online Jan 14, 2012. doi: 10.3748/wjg.v18.i2.99
Current treatment options and response rates in children with chronic hepatitis C
Stefan Wirth
Stefan Wirth, Helios Medical Centre Wuppertal, Department of Pediatrics, Witten-Herdecke University, D-42283 Wuppertal, Germany
Author contributions: Wirth S was the sole contributor to this manuscript.
Correspondence to: Stefan Wirth, MD, Professor, Helios Medical Centre Wuppertal, Department of Pediatrics, Witten-Herdecke University, Heusnerstr. 40, D-42283 Wuppertal, Germany. stefan.wirth@helios-kliniken.de
Telephone: +49-202-8963833 Fax: +49-202-8963834
Received: April 20, 2011
Revised: June 16, 2011
Accepted: June 23, 2011
Published online: January 14, 2012

Vertical transmission has become the most common mode of transmission of hepatitis C virus (HCV) in children. The rate of perinatal transmission from an HCV-infected mother to her child ranges from 2% to 5% and the prevalence of HCV in children in developed countries ranges between 0.1% and 0.4%. Spontaneous viral clearance seems to be dependent on the genotype and has been reported between 2.4%-25%. For chronically infected patients, treatment with recombinant polyethylene glycol (PEG)-interferon α-2b and daily ribavirin has now been approved as standard treatment for children 2-17 years of age. In five large prospective studies, a total of 318 children and adolescents aged 3-17 years were treated either with subcutaneous PEG-interferon α-2b at a dose of 1-1.5 μg/kg or 60 μg/m² once a week in combination with oral ribavirin (15 mg/kg per day) or PEG-interferon α-2a with ribavirin. Subjects with genotype 1 and 4 received the medication for 48 wk and individuals with genotype 2 and 3 mainly for 24 wk. Overall sustained viral response (SVR) was achieved in 193/318 (60.7%) of treated patients. Stratified for genotype; 120/234 (51%) with genotype 1, 68/73 (93%) with genotype 2/3, and 6/11 (55%) with genotype 4 showed SVR. Relapse rate was between 7.7% and 17%. Overall, treatment was well tolerated; however, notable side effects were present in approximately 20%. According to recent experiences in the treatment of chronic hepatitis C in children and adolescents, a combination of PEG-interferon α with ribavirin has been found to be well tolerated and highly efficacious, particularly in individuals with genotype 2/3. Thus, this treatment can be recommended as standard of care until more effective treatment options will become available for genotype 1 patients.

Keywords: Chronic hepatitis C, Treatment, Children, Polyethylene glycol-interferon and ribavirin, Response rate