Pediatric hepatitis C infection: to treat or not to treat... what's the best for the child?

Objectives: Pediatric hepatitis C mainly occurs through mother to child transmis- sion, to date. Children usually present a mild dis- ease, but they are not spared from its long-term complications. Thus this infection cannot be un- derestimated in children and intervention is nec- essary. Current treatment is based on the admin- istration of pegylated-interferon associated with ribavirin, but few studies evaluated the efficacy and safety of this therapeutic protocol. Moreover, there is still no clarity on who, when and how to treat pediatric patients. This article, based on the information in literature, provides an overview of the main aspects of the disease, with particular at- tention to treatment. Methodology and Results: We describe the dif- ferent treatment options available. About the asso- ciation peginterferon plus ribavirin, we analyze thir- teen non-randomized studies and one trial, found in recent literature. These studies are not directly compared because of differences in age, type of in- fection (vertical or not), viral genotypes and dura- tion of treatment, between groups enrolled. The overall sustained viral response rate ranges from 28.6% to 81.8%. The rate of treatment success is higher in children infected with genotypes 2 and 3 than with other genotypes. The therapy does not in- duce severe adverse effects and children present better tolerance to antiviral than adults. Conclusions: The pharmacological efficacy of peginterferon and ribavirin seems to be proven by data collected in studies cited, but there are dif- ferent opinions about who, when and how to treat children infected. Thus, further research is need- ed to define the best management of vertical ac- quired hepatitis C.