Question

Management of a child with Hepatitis C.

Hint:

DAAs are the cornerstone of HCV treatment in children and offer high cure rates with minimal side effects.

Answer 1

The management of a child with Hepatitis C (HCV) includes antiviral therapy, monitoring liver function, and preventing complications. The treatment strategy is dependent on the child's age, HCV genotype, and the presence of any liver damage.
1. Initial Assessment:
- Liver Function Tests (LFTs): Monitoring levels of AST, ALT, and bilirubin to assess liver involvement.
- HCV RNA Test: Quantitative PCR test to measure the viral load and determine the amount of virus in the blood.
- Genotype Testing: To determine the most effective antiviral regimen, particularly in determining if the child has genotype 1 or another subtype.
- Liver Biopsy or Elastography: In some cases, a liver biopsy or non-invasive imaging (e.g., elastography) may be required to assess liver fibrosis or cirrhosis.
2. Antiviral Therapy:
- Direct-acting antivirals (DAAs): The mainstay of treatment for children over the age of 3 years with chronic HCV. Commonly used DAAs include sofosbuvir, ledipasvir, glecaprevir/pibrentasvir, and velpatasvir.
- Treatment Duration: Depending on the child’s genotype, treatment may last between 8-12 weeks. The goal is to achieve sustained virologic response (SVR), meaning undetectable HCV RNA 12 weeks after completing therapy.
3. Monitoring:
- Follow-up testing: Regular follow-up with liver function tests and HCV RNA testing during and after treatment to assess treatment response.
- Screening for Liver Damage: Regular screening for liver damage (including cirrhosis and hepatocellular carcinom if the child has chronic HCV.
4. Management of Complications:
- Liver transplantation: In severe cases with cirrhosis or liver failure, liver transplantation may be necessary.
- Supportive care: Symptom management for fatigue or pruritus and maintaining a healthy lifestyle with balanced nutrition.
5. Prevention:
- Vaccination: Vaccination against Hepatitis A and B is recommended to prevent further liver damage in children with chronic HCV.
- Psychosocial Support: Counseling and support for the child and family, particularly regarding the chronic nature of the disease and the treatment process.