Medical Progress: Toward Hepatitis C Elimination

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JE Squires, WF Balistreri. J Pediatr 2020; 221: 12-22. Full text: Treatment of Hepatitis C: A New Paradigm toward Viral Eradication

This is a terrific article describing the improvements in treatment and challenges ahead for hepatitis C infection.

The authors note that widespread treatment has led to recommendations that primary health providers manage treatment in most adults.  Given the safety and effectiveness of these newer agents, the authors propose a similar algorithm for children (Figure 3).

The authors note the following:

“Just as has occurred in adults, the rate of discovery related to pediatric HCV therapy is outpacing traditional publication methods and many recommendations are no sooner published than they are “outdated” as newer data re-shapes the therapeutic landscape. To combat this challenge, the AASLD and IDSA have partnered to create an updated web experience resource to facilitate rapid access to treatment information (https://www.hcvguidelines.org/). A section of this document is dedicated to children, however, as of this writing, a similar comprehensive ‘living’ document is not available for pediatric populations, thus, care teams should be cognizant of the most current published data and increase their awareness of upcoming studies and DAA’s ‘in the pipeline’ that may soon be available.”

My take (borrowed from authors):

  • “Every child deserves equitable access to a cure for HCV.”
  • “Progress toward elimination of HCV infection in the US is at hand; however, both community/primary care practices and federal commitment will be required.”
  • “The role of the primary care practitioner will be enhanced [and needs to be incentivized]. It is likely that the new paradigm will be to screen and to initiate DAA treatment in patients with HCV infection.”
  • “Consultation with a hepatologist/infectious disease specialist would, thus, be reserved for selected patients (nonresponsive or those with advanced fibrosis).”

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