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World J Gastroenterol. Nov 21, 2014; 20(43): 15965-15974
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.15965
New treatments for chronic hepatitis C: An overview for paediatricians
Daniele Serranti, Giuseppe Indolfi, Massimo Resti
Daniele Serranti, Department of Health Sciences, University of Florence, I-50139 Firenze, Italy
Giuseppe Indolfi, Massimo Resti, Paediatric and Liver Unit, Meyer Children’s University Hospital of Florence, I-50139 Firenze, Italy
Author contributions: Indolfi G and Serranti D contributed equally to this work; Indolfi G and Serranti D performed the literature research and wrote the first draft of the manuscript; Resti M revised the entire document.
Correspondence to: Giuseppe Indolfi, MD, Paediatric and Liver Unit, Meyer Children’s University Hospital of Florence, Viale G. Pieraccini 24, I-50139 Firenze, Italy. g.indolfi@meyer.it
Telephone: +39-55-5662410 Fax: +39-55-5664000
Received: December 3, 2013
Revised: June 23, 2014
Accepted: August 13, 2014
Published online: November 21, 2014
Abstract

Pegylated interferon (IFN) α-2a or 2b in combination with ribavirin for children aged 3 years and older is the standard treatment for paediatric chronic hepatitis C. This treatment regimen was developed firstly in adults. In recent years, a number of direct-acting antiviral agents (DAAs) are under development for treatment of chronic hepatitis C virus (HCV) infection. These agents block viral replication inhibiting directly one of the several steps of HCV lifecycle. DAAs are classified into several categories based on their molecular target: HCV NS3/4A protease inhibitors, HCV NS5B polymerase inhibitors and HCV NS5A inhibitors. Other promising compounds are cyclophilin A inhibitors, mi-RNA122 and IFN-λ. Several new drugs associations will be developed in the near future starting from the actual standard of care. IFN-based and IFN-free regimens are being studied in adults. In this constantly evolving scenario new drug regimens targeted and suitable for children would be possible in the next future. Especially for children, it is crucial to identify the right combination of drugs with the highest potency, barrier to resistance and the best safety profile.

Keywords: Hepatitis C virus, Children, Treatment, Interferon, Ribavirin, Daclatasvir, Sofosbuvir, Efficacy, Safety

Core tip: The discovery of new drugs and new therapeutic regimens is changing radically the approach to chronic hepatitis C virus infection. The efficacy and safety of pegylated interferons (IFNs) and ribavirin are well known in children. The introduction of direct antiviral agents has already changed the standard of care in adults. Other new drugs and IFN free regimens have been proposed with promising results. This scenario could pone new perspectives in treatment of children with chronic hepatitis C.