Recommendations for HCV Testing of Perinatally Exposed Children and Siblings of Children With HCV Infection |
|
|---|---|
| RECOMMENDED |
RATING 
|
| All children born to HCV-infected women should be tested for HCV infection. Testing is recommended using an antibody-based test at or after 18 months of age. | I, A |
| Repetitive HCV RNA testing prior to 18 months of age is not recommended. | III, A |
| Children who are anti-HCV positive after 18 months of age should be tested with an HCV-RNA assay after age 3 to confirm chronic hepatitis C infection. | I, A |
| The siblings of children with vertically-acquired chronic HCV should be tested for HCV infection, if born from the same mother. | I, C |
Recommendations for Counseling Parents Regarding Transmission and Prevention in Children with HCV Infection |
|
|---|---|
| RECOMMENDED |
RATING
|
| Parents should be informed that hepatitis C is not transmitted by casual contact and, as such, children with HCV infection do not pose a risk to other children and can participate in school, sports, and athletic activities, and engage in all other regular childhood activities without restrictions. | I, B |
| Parents should be informed that universal precautions should be followed at school and in the home of children with HCV infection. Educate families and children about the risk and routes of HCV transmission, and the techniques for avoiding blood exposure, such as avoiding the sharing of toothbrushes, razors, and nail clippers, and the use of gloves and dilute bleach to clean up blood. | I, B |
Recommendations for Monitoring and Medical Management of Children With HCV Infection |
|
|---|---|
| RECOMMENDED |
RATING
|
| Routine liver biochemistries at initial diagnosis and at least annually thereafter are recommended to assess for disease progression. | I, C |
| Appropriate vaccinations are recommended for children with chronic HCV infection who are not immune to hepatitis B virus and/or hepatitis A virus to prevent these infections. | I, C |
| Disease severity assessment via routine laboratory testing and physical examination, as well as use of evolving noninvasive modalities (ie, elastography, imaging, or serum fibrosis markers) is recommended for all children with chronic HCV infection. | I, B |
| Children with cirrhosis should undergo hepatocellular carcinoma (HCC) surveillance and endoscopic surveillance for varices per standard recommendations. | I, B |
| Hepatotoxic drugs should be used with caution in children with chronic HCV infection after assessment of potential risks versus benefits of treatment. Use of corticosteroids, cytotoxic chemotherapy, and/or therapeutic doses of acetaminophen are not contraindicated in children with chronic HCV infection. | II, C |
| Solid organ transplantation and bone marrow transplantation are not contraindicated in children with chronic HCV infection. | II, C |
| Anticipatory guidance about the potential risks of ethanol for progression of liver disease is recommended for adolescents with chronic HCV infection and their families. Abstinence from alcohol and interventions to facilitate cessation of alcohol consumption, when appropriate, are advised for all persons with chronic HCV infection. | I, C |
Recommendations for Whom and When to Treat Among Children and Adolescents With HCV Infection |
|
|---|---|
| RECOMMENDED |
RATING
|
| Direct-acting antiviral (DAA) treatment with an approved regimen is recommended for all children and adolescents with HCV infection aged ≥3 years as they will benefit from antiviral therapy, regardless of disease severity. | I, B |
| The presence of extrahepatic manifestations—such as cryoglobulinemia, rashes, and glomerulonephritis—as well as advanced fibrosis should lead to early antiviral therapy to minimize future morbidity and mortality. | I, C |
|
Recommended regimens listed by pangenotypic, evidence level and alphabetically for Treatment-Naive or Interferon-Experienced Children and Adolescents Without Cirrhosis or With Compensated Cirrhosisa |
||
|---|---|---|
| RECOMMENDED | DURATION |
RATING
|
| Combination of glecaprevir/pibrentasvir (weight-based dosing; see Table 1) for children aged ≥ 3 with any genotypeb | 8 weeks | I, B |
| Combination of sofosbuvir/velpatasvir (weight-based dosing; see Table 2) for children ≥3 of age with any genotype | 12 weeks | I, B |
| Combination of ledipasvir/sofosbuvir (weight-based dosing; see Table 3) for children aged ≥3 years with genotype 1, 4, 5, or 6 | 12 weeks | I, B |
|
a Child-Pugh A b A longer duration of therapy (ie, 16 weeks) may be needed for genotype 3 interferon-experienced patients. |
||
|
Recommended regimens listed by pangenotypic, evidence level and alphabetically for DAA-Experienced Children and Adolescents, Without Cirrhosis or With Compensated Cirrhosisa |
||
|---|---|---|
| RECOMMENDED | DURATION |
RATING
|
| Genotype 1, 2, 4, 5, or 6: Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg) for adolescents aged ≥12 years or weighing ≥45 kg with prior exposure to an interferon-based regimen (± ribavirin) and/or sofosbuvir but no exposure to NS3/4A or NS5A protease inhibitors, without cirrhosis | 8 weeks | I, C |
| Genotype 1, 2, 4, 5, or 6: Combination of glecaprevir/pibrentasvir (weight-based dosing; see Table 1) with prior exposure to an interferon-based regimen (± ribavirin) and/or sofosbuvir but no exposure to NS3/4A or NS5A protease inhibitors, with compensated cirrhosisa | 12 weeks | I, C |
| Genotype 3: Combination of glecaprevir/pibrentasvir (weight-based dosing; see Table 1) with prior exposure to an interferon-based regimen (± ribavirin) and/or sofosbuvir but no exposure to NS3/4A or NS5A protease inhibitors, without cirrhosis or with compensated cirrhosisa | 16 weeks | I, C |
| Genotype 1- 6: Combination of glecaprevir/pibrentasvir (weight-based dosing; see Table 1) with prior exposure to NS3/4A protease inhibitors but no NS5A inhibitor exposure, without cirrhosis or with compensated cirrhosisa | 12 weeks | I, C |
| Genotype 1- 6: Combination of glecaprevir/pibrentasvir (weight-based dosing; see Table 1) with prior exposure to an NS5A inhibitor but no NS3/4A protease inhibitor exposure, without cirrhosis or with compensated cirrhosisa | 16 weeks | I, C |
| Genotypes 1-6: Combination of sofosbuvir/velpatasvir (weight-based dosing; see Table 2) with prior exposure to an interferon-based regimen (± ribavirin) and/or sofosbuvir but no exposure to NS3/4A or NS5A protease inhibitors, without cirrhosis or with compensated cirrhosis | 12 weeks | I, C |
| Genotypes 1-6: Combination of sofosbuvir/velpatasvir (weight-based dosing; see Table 2) with weight-based ribavirin (see Table 4) with prior exposure to an interferon-based regimen (± ribavirin) and/or sofosbuvir but no exposure to NS3/4A or NS5A protease inhibitors, with decompensated cirrhosis | 12 weeks | I, C |
| Genotype 4, 5, or 6: Combination of ledipasvir/sofosbuvir (weight-based dosing; see Table 3) for children and adolescents aged ≥3 years with prior exposure to an interferon (± ribavirin) plus an HCV protease inhibitor regimen, without cirrhosis or with compensated cirrhosisa | 12 weeks | I, C |
| Genotype 1: Combination of ledipasvir/sofosbuvir (weight-based dosing; see Table 3) for children and adolescents aged ≥3 years with prior exposure to an interferon (± ribavirin) plus an HCV protease inhibitor regimen, without cirrhosis | 12 weeks | I, C |
| Genotype 1: Combination of ledipasvir/sofosbuvir (weight-based dosing; see Table 3) for children and adolescents aged ≥3 years with prior exposure to an interferon (± ribavirin) plus an HCV protease inhibitor regimen, with compensated cirrhosisa | 24 weeks | I, C |
| a Child-Pugh A | ||
Table 1: Weight-Based Dosing of Glecaprevir/Pibrentasvir for Children Aged ≥3 Years of Age
Body Weight |
Once Daily Dose of Glecaprevir/Pibrentasvir |
|---|---|
| <20 kg | 150 mg/60 mg |
| ≥20 kg to <30 kg | 200 mg/80 mg |
| ≥30 kg to <45 kg | 250 mg/100 mg |
| 45 kg and greater or 12 years of age and older | 300 mg / 120 mg / day |
Table 2: Weight-based dosing for sofosbuvir/velpatasvir fixed dose combination in children ≥ 3 years of age
Body Weight |
Once Daily Dose of Sofosbuvir/Velpatasvir |
|---|---|
| < 17 kg | 150 mg/37.5 mg |
| 17 - < 30 kg | 200 mg/50 mg |
| ≧ 30 kg | 400 mg/100 mg |
Table 3: Weight-Based Dosing of Ledipasvir/Sofosbuvir for Children Aged ≥3 Years
Body Weight |
Once Daily Dose of Ledipasvir/Sofosbuvir |
|---|---|
| <17 kg | 33.75 mg/150 mg |
| 17 to <35 kg | 45 mg/200 mg |
| ≥35 kg | 90 mg/400 mg per day |
Table 4. Weight-Based Dosing of Ribavirin for Children Aged ≥3 Years
Body Weight |
Daily Dose of Ribavirin (divided AM and PM) |
|---|---|
| <47 kg | 15 mg/kg |
| 47 to 49 kg | 600 mg |
| 50 to 65 kg | 800 mg |
| 66 to 80 kg | 1000 mg |
| >80 kg | 1200 mg |