Approach Considerations
For acute hepatitis C virus (HCV) infection, supportive care is the mainstay of treatment. Early initiation of antiviral therapy is not defined.
In chronic HCV infection, the goal is to identify complications and suitable candidates for antiviral therapy. The purpose of antiviral therapy is to ameliorate symptoms and reduce the risk of progressive liver disease. Consultation with a gastroenterologist may be indicated.
Long-term monitoring is essential because the risk of liver cancer is still high, even in sustained virologic responders. [8] In children, a well-defined interval for monitoring is not known, but every 6-12 months is probably reasonable to assess alanine aminotransferase (ALT) levels and clinical status.
Serum ALT levels have no consistent relationship to liver histologic findings. Longitudinal assessment of hepatitis C virus RNA provides a strong correlation with liver histologic results but is a weaker predictor of rate of progression.
Consider liver transplantation in patients with advanced liver disease. Surgical intervention may also be necessary for complications such as portal hypertension and hepatocellular carcinoma (HCC).
See also Pediatric Hepatitis A and Pediatric Hepatitis B.
Antiviral Therapy
The initiation of treatment is a complex decision involving knowledge of the patient's HCV genotype, compliance and social support, comorbid psychiatric conditions (depression can be worsened significantly by treatment), and progression of liver disease. Children younger than 3 years should not be treated due to a lack of approved medications and the possibility of spontaneous clearance of infection without therapy.
Identify suitable candidates for antiviral therapy, although all patients with chronic infection are potential candidates. Treatment is recommended for patients with chronic infection who have a persistently elevated serum ALT level, portal or bridging fibrosis, and at least moderate inflammation and necrosis at liver biopsy.
Consider treatment for other patients on an individual basis. Do not use antiviral therapy to treat patients with decompensated cirrhosis.
Deterrence/Prevention
For individuals exposed to hepatitis C virus (HCV), passive immunization is not recommended. No vaccine has been developed for hepatitis C virus. People with HCV should be vaccinated against hepatitis A and B virus to prevent worsening of liver disease. Household contacts of children with HCV should be vaccinated against hepatitis A virus.
Discourage users of intravenous drugs from sharing needles. Adhere to universal precautions. Breastfeeding is not contraindicated for mothers with HCV infection. There is no need to bar children with HCV infection from attending daycare.
Infected patients with multiple partners should use barrier protection during sex. No special precautions are needed for monogamous relationships.
Instruct the patient not to share personal care articles such as toothbrushes or razors.
Blood, organ, or sperm donation from patients with hepatitis C virus infection is not permitted.
Long-Term Monitoring
Long-term monitoring is essential in patients with chronic HCV infection because the risk of liver cancer is high, even in sustained virologic responders. [8] The prothrombin time is useful for assessing liver function. The serum alpha-fetoprotein assay is a potential screening test for HCC. Ultrasonography is potentially useful to monitor for hepatitis C virus–related complications such as portal hypertension and HCC.
