Adolescent Hepatitis C: Prevalence, Impact, and Management Challenges

Figures & data

Figure 1 Flow diagram for HCV diagnosis and management in adolescents.

Notes: ^ǂSpecific guidelines for when to test adolescents are not available, but the WHO recommends targeted interventions to these populations⁶⁰ ¥DAA regimen depends on genotype, patient’s age and weight,^17,48–50 see Table 2. ^δSee Table 1 for details.

Abbreviations: DAA, direct antiviral agent; DBS, dry blood spots; EIA, enzyme immunoassay; HCV, hepatitis Cvirus; IVDU, intravenous drug use; MSM, men who have sex with men; POC, point of care testing.

Table 1 Suggested Monitoring for Children and Adolescents with Chronic HCV by the NASPGHAN (Adapted from Leung et al 2020)

Test	Pretreatment	During Treatment	Post Treatment
AST, ALT, GGT, TB, DB	Annual	Every 4 weeks	At 12 weeks If cirrhotic every 6 months
CBC	Annual	Every 4 weeks	If clinically indicated
PT, INR	Annual	If clinically indicated	If clinically indicated
HCV viral load	Annual	Every 4 weeks	At 12 weeks and after 12 months
Urine HCG (childbearing aged females)	Prior to treatment	Every 4 weeks if sexually active	N/A
AFP	Cirrhotic: every 6 months	N/A	Cirrhotic: every 6 months

Abbreviations: AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyl transferase; TB, total bilirubin; DB, direct bilirubin; CBC, complete blood count; PT, prothrombin time; INR, international normalized ratio; HCG, human chorionic gonadotropin; N/A, not applicable; AFP, alpha-fetoprotein.

Table 2 Recommended DAA Regimens per Different Guideline for Children Naive of DAA Therapy or Previously Treated with Interferon, without Cirrhosis or with Compensated Cirrhosis

Drug Combination/ Guideline	Genotypes	Age/Weight	Duration
Ledipasvir/sofosbuvir AASLD/IDSA^Citation48 ESPGHAN^Citation49 NASPGHAN^Citation17 WHO^Citation50	1,4,5,6	≥ 3 years	12 weeks
Glecaprivir/pibrentasvir ESPGHAN^Citation49 NASPGHAN^Citation17	Any genotype	≥ 12 years or ≥ 45 kg	8 weeks
Sofosbuvir plus Ribavirinǂ AASLD/IDSA^Citation48 ESPGHAN^Citation49 NASPGHAN^Citation17 WHO^Citation50	2,3	≥ 3 years	12 weeks for genotype 2 24 weeks for genotype 3

Note: For specific dosing recommendations refer to each guideline.

Abbreviations: AASLD/IDSA, American Association for the Study of Liver Diseases and Infectious Diseases Society of America; ESPGHAN, European Society for Paediatric Gastroenterology, Hepatology and Nutrition; NASPGHAN, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; WHO, World Health Organization.

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