The Hepatitis Expert Team of the Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition wrote this position paper with the goal of systematically evaluating clinical practice guidelines (CPGs), medical consensus, and position papers on the use of direct-acting antivirals (DAA) to treat chronic hepatitis C virus (HCV) infection in adolescents and children. Between 2011 and 2019, CPGs, medical consensus, and position papers were identified using MEDLINE, Cochrane-Library, National Guideline Clearinghouse, and websites of relevant societies/organizations. A total of five documents were reviewed: three CPGs, one medical consensus, and one position paper. All of the studies recommended DAA therapy for adolescents with persistent HCV infection. Similarly, all of these papers uniformly advocated delaying treatment for children aged 3 to 11 until DAA established the standard of care. Finally, none of the included papers advocated for treating children under the age of three. In contrast, there was substantial disparity among the recovered papers addressing specific DAA regimens and treatment methods.
There is broad agreement that DAA should be used to treat all adolescents with chronic HCV infection and that treatment should be delayed in younger children until these medicines are licensed. Therapies based on interferons should be avoided. Specific advice for which DAA regimen to adopt and treatment duration ranged widely. If we want to eliminate HCV in children, key players must gather to standardize treatment techniques on a worldwide scale.
