Treatment of hepatitis C in children: a systematic review.
BACKGROUND
Current guidelines recommend children be treated for hepatitis C virus (HCV) using the same principles applied in adults. There are however few published studies which assess the efficacy and safety of HCV therapy in children.


RESULTS
A systematic review of the literature was completed for studies of any design that evaluated HCV therapy in children. The primary outcome was sustained virologic response (SVR), with sub-group analysis of response rates by genotype. There were 4 randomized controlled trials (RCTs) and 31 non-randomized studies, all involving interferon, pegylated interferon (PEG-IFN), or combinations of these drugs with ribavirin. The SVR rate could not be directly compared as the populations and interventions differed across studies. Genotype was not reported or differed substantially from study to study. The overall SVR rate for PEG-IFN and ribavirin ranged from 30 to 100% which is comparable to the rate in adults. Similar to adults, the SVR rates were significantly higher in children with genotype 2 or 3 compared to genotype 1. Adverse effects were primarily flu-like symptoms and neutropenia. There were insufficient data to assess the applicability of the week 12 stop rule (stopping therapy at week 12 if there is less than a 2 log drop in HCV RNA) or the efficacy of shortening therapy to 24 weeks in children with genotype 2 and 3.


CONCLUSIONS
Current guidelines for the treatment of HCV in children are based on limited data. Further research is needed to define the optimal therapy for HCV in children.
Hu
Jia
J
Department of Pediatrics, University of Alberta, Edmonton, Canada. jr3@ualberta.ca
Doucette
Karen
K
Hartling
Lisa
L
Tjosvold
Lisa
L
Robinson
Joan
J
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D005838:Genotype; D006526:Hepatitis C / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007372:Interferons / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons