ESPGHAN recommendations on treatment of chronic hepatitis C virus infection in adolescents and children including those living in resource-limited settings

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease worldwide, with more than three million viraemic adolescents and children. Treatment of adults with HCV infection and HCV-related liver disease has advanced considerably thanks to development and improvements in therapy. Direct-acting antiviral regimens are safe and effective. Three regimens with pangenotypic activity (glecaprevir/pibrentasvir, sofosbuvir/velpatasvir and sofosbuvir/velpatasvir/voxilaprevir) and three regimens with genotype-specific activity (sofosbuvir/ribavirin, sofosbuvir/ledipasvir and elbasvir/grazoprevir) have been approved with age-specific limitation for treatment of children with chronic hepatitis C by the European Medicines Agency and the United States Food and Drug Administration. The World Health Organization has set the ambitious target to eliminate hepatitis C as a major public health threat by 2030 and based its actions against HCV on the large use of direct acting antivirals. These updated European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommendations on treatment of hepatitis C describe the optimal therapeutic management of adolescents and children with HCV infection including specific indications for those living in resource-limited settings. What is Known Direct-acting antiviral drug regimens are highly effective and safe for treatment of adults, adolescents and children with chronic hepatitis C. Two combination regimens with pangenotypic activity (sofosbuvir/velpatasvir and glecaprevir/pibrentasvir) and two with genotype-specific activity (sofosbuvir/ledipasvir and sofosbuvir plus ribavirin) have been approved by both the European Medicines Agency and the United States Food and Drug Administration for use in adolescents and children aged 3 years and older with chronic hepatitis C.What is New We recommend treatment using direct-acting antiviral regimens for all adolescents and children 3 years of age and above with chronic hepatitis C, regardless of stage of disease. Pangenotypic and genotype-specific direct-acting antiviral regimens are equally recommended for treatment. Pangenotypic, ribavirin-free and regimens with the shortest treatment duration are preferrable when available. Sofosbuvir plus daclatasvir may be considered for adolescents and children with chronic hepatitis C in resource-limited settings, as it is highly effective and widely available as low-cost generic formulations.