The prevalence of hepatitis C virus (HCV) infection is lower in children than in adults. Perinatal transmission is by far the most common source of HCV infection in children. The incidence of HCV vertical transmission is approximately 1 to 5 percent in HCV-RNA-positive mothers, with the highest risk in mothers with high HCV viral load. Infections acquired during infancy (either by transfusion or through perinatal transmission) are most likely to clear spontaneously, with spontaneous clearance rates ranging from 20 to 45 percent. The development of advanced liver disease is uncommon until more than 30 years after infection in children.
Children whose mothers are known to be infected with HCV, HCV antibody should be performed after 18 months of age. Initial diagnostic evaluation for chronic HCV typically begins with an antibody test. A reactive or indeterminate/equivocal antibody test should be followed by HCV ribonucleic acid (RNA) testing. If HCV RNA is detected, the diagnosis of HCV infection is confirmed. These patients should be further evaluated to determine the genotype and extent of disease. Individuals with HCV infection should also be screened for coinfection with hepatitis B virus (HBV) and HIV due to common modes of transmission. HCV genotyping is useful for guiding the selection and duration of therapy. The treatment of chronic HCV is rapidly evolving. Treatment is now available for most pediatric patients ages 12 and older, using direct acting antiviral agents (DAAs), which are highly effective. For children younger than 12 years of age with HCV infection, it is advised to defer treatment until an all-oral DAA regimen is available. Mother-to-child transmission of HCV does not occur if the mother has been successfully treated and is not viremic. Therefore, women with HCV should be treated prior to conception.
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