Hepatitis C virus infection in children and adolescents

Introduction Hepatitis C virus (HCV) infection remains a major public health burden, with an estimated worldwide prevalence of 2.5% of the population (177.5 million infected adults); this ranges from 1.3% in the Americas to 2.9% in Africa. In the United States alone, an estimated 3 million to 4 million persons are chronically infected with HCV, and approximately half are unaware of their infectious status and do not receive appropriate care. The current Centers for Disease Control recommendations for HCV screening and advances in HCV treatment are anticipated to diminish the clinical burden of the disease; however, medication cost and access to care remain significant barriers. In order to provide a more structured approach to the dynamic landscape of HCV, adult-centric guidelines have been established. These provide health care professionals with timely guidance as new therapies become available and are integrated into treatment regimens. In children and adolescents as in adults, HCV infection is suspected to be grossly underestimated. HCV infection across the pediatric age spectrum differs from infection acquired later in life in a variety of ways, including modes of transmission, rates of spontaneous clearance or progression of fibrosis, the potential duration of chronic infection when acquired at birth, and significantly, available treatment options. While several reviews have recently been published regarding aspects of HCV infection in adults, our goal is to present a practical overview of the epidemiology, diagnosis, clinical features, natural history, and management of HCV infection in children and adolescents.