Management of hepatitis C in children and adolescents during COVID-19 pandemic

Table 1 Direct-acting antivirals approved for adolescents aged 12 to 17 years in Europe (May 2020)[20,22-24]

Direct-acting antivirals regimen (doses per d)	Hepatitis C virus genotype	Patients	Duration of treatment in wk
Sofosbuvir/ledipasvir (400/90 mg)	1	Treatment-naïve with or without cirrhosis or treatment-experienced without cirrhosis	12
		Treatment-experienced with cirrhosis	24
	4, 5, 6	Treatment-naïve or treatment-experienced, with or without cirrhosis	12
Sofosbuvir + ribavirin (400 mg + 15 mg/kg)	2	Treatment-naïve or treatment-experienced, with or without cirrhosis	12
	3		24
Glecaprevir/pibrentasvir (300/120 mg)	All genotypes	Without cirrhosis	8
	All genotypes	With cirrhosis	12
	3	Treatment experienced	16

Table 2 Recommendations for the management of pediatric patients with chronic hepatitis C virus infection during the coronavirus disease 2019 pandemic[35,39]

Management	Recommendation
Physical distancing	Recommended
Patient education on risk and precaution on COVID-19	Recommended
Testing for severe acute respiratory syndrome coronavirus infection	Recommended in patients with clinical symptoms suggesting COVID-19, or with household contact with an infected family member, or requiring hospitalization
Visits to specialized centers	Should be postponed
Routine laboratory testing	Should be performed (only if truly necessary) locally/offsite
Direct-acting antiviral therapy already initiated	Should be continued
Starting direct-acting antiviral treatment	May be postponed in patients with stable chronic hepatitis C. If possible, it should be considered in patients with significant fibrosis or human immunodeficiency virus/hepatitis C virus coinfection
Telemedicine/visits by phone	Recommended instead of face-to-face visits whenever possible
Drug supply	Home delivery or sending prescriptions by e-mail
Liver-related diagnostic procedures	Should be deferred unless they are likely to change management

COVID-19: Coronavirus disease 2019.