Treatment of Chronic Hepatitis C with Decompensated Liver Cirrhosis (Child-Pugh B or C) in Patients Under 18
Clinical Scenario
This protocol addresses children and adolescents younger than 18 years who have chronic hepatitis C and have developed decompensated cirrhosis of the liver, classified as Child-Pugh B or C. This represents a high-risk subgroup requiring a carefully selected antiviral strategy and specialist oversight.
Key Condition
Decompensated Cirrhosis — Child-Pugh B or C
DAA-based pangenotypic regimens are the most suitable options for patients with decompensated (Child-Pugh B or C) cirrhosis. Due to the rarity of this presentation in the pediatric age group, management should be conducted in experienced pediatric liver centres.
Treatment Approach
The recommended approach for this population involves a fixed-dose combination antiviral regimen administered orally once daily. The full regimen — including the specific agents, weight-based components, and duration — is detailed in the structured protocol.
Contraindication: Protease inhibitor (–previr)-containing regimens are contraindicated in this setting due to a higher risk of toxicity.
Treatment should be carried out in experienced paediatric liver centres. In the absence of dedicated paediatric evidence, adult guidelines provide additional reference.
Treatment Goal
The primary endpoint is undetectable HCV RNA in blood (lower limit of detection 15 IU/mL) at 12 weeks after completing treatment — sustained virological response (SVR12).
References
DOI: 10.1002/jpn3.12160
- DAA-based pangenotypic regimens are the most suitable options for patients with decompensated (Child-Pugh B or C) cirrhosis.
- In the unlikely event of decompensated cirrhosis patients younger than 18 years of age should be treated in experienced pediatric liver centers.
- Thus, the fixed-dose combination of sofosbuvir/velpatasvir with weight-based ribavirin is the treatment of choice for adult patients with decompensated (Child-Pugh B or C) cirrhosis.
- Protease inhibitor-containing regimens are contraindicated because of higher risk of toxicity.
- The endpoint of therapy with DAA in children is undetectable HCV RNA in blood by a sensitive assay with a lower limit of detection of 15 IU/mL 12 weeks after the end of treatment (SVR12).
View source ↗