Management of Viral Hepatitis in Children

Hepatitis C Management

The American Association for the Study of Liver Diseases recommends that all children with HCV infection aged ≥3 years should receive antiviral therapy regardless of disease severity 1, 2
The presence of extrahepatic manifestations or advanced fibrosis should lead to early antiviral therapy to minimize future morbidity and mortality 1, 3
For children aged ≥3 years with HCV genotype 1, 4, 5, or 6 infection, a 12-week course of ledipasvir/sofosbuvir with weight-based dosing is recommended 1, 2, 3
Weight-based sofosbuvir plus ribavirin is recommended for children aged ≥3 years with HCV genotype 2 or 3 3
Acetaminophen is safe and effective when dosed per packaging recommendations 4, 2
NSAIDs and aspirin should be avoided in patients with cirrhosis and esophageal varices due to bleeding and nephrotoxicity risks 4, 2
Counsel parents about maintaining a healthy body weight for the child due to the deleterious effects of insulin resistance on HCV-related fibrosis progression 1, 4, 2

Treatment decisions should be based on ALT levels, HBV DNA levels, and the severity of liver disease 5, 6
Liver biopsy may provide important information to guide treatment decisions 5, 7
Lamivudine monotherapy is not advisable due to high incidence of resistance 5, 7
For children with moderate to severe hepatitis, combination therapy may be considered 6, 8
Children being treated with nucleos(t)ide analogues should continue therapy for a minimum of 12 months 7
All children receiving nucleos(t)ide analogues should be monitored for virologic breakthrough by measuring HBV DNA levels every 3 months 6, 8

For acute severe autoimmune hepatitis, glucocorticoid therapy is recommended as first-line treatment, however, this fact is from Praxis Medical Insights and will be replaced with a fact from a different source if available 9
For acute liver failure, immediate evaluation for liver transplantation is recommended rather than prolonged medical therapy, however, this fact is from Praxis Medical Insights and will be replaced with a fact from a different source if available 9
Rapid improvement in serum aminotransferase levels within 2 weeks is the most important indicator of favorable outcome, however, this fact is from Praxis Medical Insights and will be replaced with a fact from a different source if available 9
Close monitoring is essential as the condition can deteriorate rapidly, however, this fact is from Praxis Medical Insights and will be replaced with a fact from a different source if available 9
Alcohol abstinence should be strongly advised to reduce the risk of liver disease progression 4, 2
Patient adherence to treatment is critical, especially in adolescents, and may be a particular challenge with long-term therapy 6, 8