关注儿童慢性丙型肝炎的治疗

南月敏; 李冬冬; 孔令波

doi:10.3969/j.issn.1001-5256.2018.02.006

关注儿童慢性丙型肝炎的治疗

DOI: 10.3969/j.issn.1001-5256.2018.02.006

河北医科大学第三医院中西医结合肝病科

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中图分类号: R725.1
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出版历程
- 出版日期: 2018-02-20

Focus on the treatment of chronic hepatitis C in children

Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University

摘要

摘要:
儿童慢性丙型肝炎发病隐匿,治疗选择较少,聚乙二醇干扰素α联合利巴韦林(PR方案),曾为标准方案,治疗应答受感染的HCV基因型、病毒载量、宿主基因多态性等因素影响,由于不良反应较多,部分患儿不能耐受。2017年9月美国肝病学会与感染病学会联合制订的《丙型肝炎检测、管理与治疗指南》建议12岁以上或体质量≥35 kg丙型肝炎患儿可采用直接抗病毒药物(DAA)治疗,基因1、4、5、6型感染患儿推荐方案为索磷布韦联合雷迪帕韦,基因2、3型推荐索磷布韦联合RBV,基因1型初治和IFNα经治无肝硬化患儿以及2、4、5、6型患儿疗程12周,基因1型IFNα经治肝硬化患儿及3型患儿疗程24周。年龄小于12岁慢性丙型肝炎儿童应用DAA的治疗方案及安全性有待进一步研究与临床验证。慢性丙型肝炎合并HIV感染及肝移植等特殊儿童人群,需结合HIV感染状况、肝移植相关并发症等进行个体化治疗。
- 肝炎,丙型,慢性 /
- 抗病毒药 /
- 治疗 /
- 儿童
Abstract:
Chronic hepatitis C in children has an insidious onset and has few available treatment options.Pegylated interferon alpha (Peg-IFNα) combined with ribavirin (RBV) , known as the PR regimen for short, used to be the standard regimen; however, treatment response is often affected by various factors including hepatitis C virus genotype, viral load, and host gene polymorphisms, and some children cannot tolerate the adverse reactions of PR regimen.HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C developed by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (AASLD/IDSA) in September, 2017 recommended that direct-acting antiviral agents (DAAs) can be used for children with hepatitis C who are aged above 12 years or have a body weight of ≥35 kg.Sofosbuvir combined with ledipasvir is the recommended regimen for children with genotype 1, 4, 5, or 6 infection, and sofosbuvir combined with RBV is recommended for children with genotype 2 or 3 infection.The course of disease is 12 weeks for previously untreated children with genotype 1 infection, children with genotype 1 infection who were treated by IFNα and do not have liver cirrhosis, or children with genotype 2, 4, 5, or 6 infection, and 24 weeks for children with genotype 1 infection who were treated by IFNαand have liver cirrhosis or children with genotype 3 infection.Further studies are needed to investigate the type of DAAs used in children with chronic hepatitis C aged < 12 years, related regimens, and their safety.As for special populations including children with chronic hepatitis C complicated by HIV infection and those treated by liver transplantation, individualized treatment regimens should be developed with reference to the status of HIV infection and complications of liver transplantation.
- hepatitis C, virus /
- antiviral agents /
- therapy /
- child

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参考文献(29)

[1]GAO YH, LIU XE, ZHUANG H.Research progress on hepatitis C in children[J].Virologica Sinica, 2016, 6 (4) :300-306. (in Chinese) 高玉华, 刘学恩, 庄辉.儿童丙型肝炎研究进展[J].中国病毒病杂志, 2016, 6 (4) :300-306.

[2]GOWER E, ESTES C, BLACH S, et al.Global epidemiology and genotype distribution of the hepatitis C virus infection[J].J Hepatol, 2014, 61 (1) :s45-s57.

[3] CHEN YS, LI L, CUI FQ, et al.A sero-epidemiological study on hepatitis C in China[J].Chin J Epidemiol, 2011, 32 (9) :888-891. (in Chinese) 陈园生, 李黎, 崔富强, 等.中国丙型肝炎血清流行病学研究[J].中华流行病学杂志, 2011, 32 (9) :888-891.

[4]RESTI M, BORTOLOTTI F, VAJRO P, et al.Guidelines for the screening and follow-up of infants born to anti-HCV positive mothers[J].Dig Liver Dis, 2003, 35 (7) :453-457.

[5]KELLY D, SHARIF K, BROWN RM, et al.Hepatocellular carcinoma in children[J].Clin Liver Dis, 2015, 19 (2) :433-447.

[6]LAGGING M, WEJSTAL R, NORKRANS G, et al.Treatment of hepatitis C virus infection for adults and children:updated Swedish consensus recommendations[J].Infect Dis (Lond) , 2016, 48 (4) :251-261.

[7]LI YY, SHI JJ, WANG FS, et al.Progress in treatment of chronic hepatitis C patients with direct antiviral drugs[J].Infect Dis Info, 2017, 30 (2) :70-74. (in Chinese) 李元元, 史继静, 王福生, 等.直接抗病毒药物对慢性丙型肝炎特殊人群的治疗进展[J].传染病信息, 2017, 30 (2) :70-74.

[8]INDOLFI G, THORNE C, SAYED MH, et al.The challenge of treating children with hepatitis C virus infection[J].J Pediatr Gastroentero Nutr, 2017, 64 (6) :851-854.

[9]El-GUINDI MA.Hepatitis C viral infection in children:updated review[J].Pediatr Gastroenterol Hepato Nutr, 2016, 19 (2) :83-95.

[10]WIRTH S, RIBES-KONINCKX C, CALZADO MA, et al.High sustained virologic response rates in children with chronic hepatitis C receiving peginterferon alfa-2b plus ribavirin[J].J Hepatol, 2010, 52 (4) :501-507.

[11]BORTOLOTTI F, VERUCCHI G, CAMMA C, et al.Long-term course of chronic hepatitis C in children:from viral clearance to end-stage liver disease[J].Gastroenterology, 2008, 134 (7) :1900-1907.

[12]JONAS MM.Children with hepatitis C[J].Hepatology, 2002, 36 (5Suppl 1) :s173-s178.

[13] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C:a 2015 update[J].J Clin Hepatol, 2015, 31 (12) :1961-1979. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.丙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1961-1979.

[14]The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America Present.HCV guidance:recommendations for testing, managing, and treating hepatitis C[S/OL]. (2017-09-21) [2017-12-19].www.hcvguidelines.org.

[15]LEE CK, JONAS MM.Treating HCV infection in children[J].Clin Liver Dis, 2015, 5 (1) :14-16.

[16]LARRAT S, VALLET S, DAVID-TCHOUDA S, et al.Naturally occurring resistance-associated variants of hepatitis C virus protease inhibitors in poor responders to pegylated interferon-ribavirin[J].J Clin Microbiol, 2015, 53 (7) :2195-2202.

[17]PAWLOWSKA M, PILARCYKA M, HALOTA W.Virologic response to treatment with Pegylated Interferon alfa-2b and Ribavirin for chronic hepatitis C in children[J].Med Sci Monit, 2010, 16 (12) :616-621.

[18]SHI YM, ZHANG B, ZHANG HF, et al.Association between interleukin-28B polymorphisms and antiviral effect in children with chronic hepatitis C[J].Chin J Hepatol, 2016, 24 (6) :446-448. (in Chinese) 史艳敏, 张冰, 张鸿飞, 等.白细胞介素28B基因多态性与慢性丙型肝炎患儿抗病毒疗效的相关性[J].中华肝脏病杂志, 2016, 24 (6) :446-448.

[19]SCHWARZ KB, GONZALEZ-PERALTA RP, MURRAY KF, et al.The combination of ribavirin and peginterferon is superior to peginterferon and placebo for children and adolescents with chronic hepatitis C[J].Gastroenterology, 2011, 140 (2) :450-458.

[20]GRANOT E, SOKAL EM.Hepatitis C virus in children:deferring treatment in expectation of direct-acting antiviral agents[J].Isr Med Assoc J, 2015, 17 (11) :707-711.

[21]WIRTH S, ROSENTHAL P, GONZALEZ-PERALTA RP, et al.Sofosbuvir and ribavirin in adolescents 12-17 years old with hepatitis C virus genotype 2 or 3 infection[J].Hepatology, 2017, 66 (4) :1102-1110.

[22]BALISTRERA WF, MURRAY KF, ROSENTHAL P, et al.The safety and effectiveness of ledipasvir-sofosbuvir in adolescents 12-17 years old with hepatitis C virus genotype 1 infection[J].Hepatology, 2017, 66 (2) :371-378.

[23]MURRAY KF, BALISTRERI W, BANSAL S, et al.Ledipasvir/ribavirin for 12 or 24 weeks is safe and effective in children 6-11years old with chronic hepatitis C infection[J].J Hepatol, 2017, 66:s57-s58.

[24]ENGLAND K, THORNE C, CASTELLI-GATTINARA G, et al.HIV and HCV progression in parenterally coinfected children[J].Curr HIV Res, 2009, 7 (3) :346-353.

[25]THORNE C;European Paediatric HIV/HCV Co-infection Study Group in the European Pregnancy and Paediatric HIV Cohort Collaboration.HIV/HCV co-infection in children and young people in Europe:results from cohort collaboration[C]//32nd Annual Meeting of the European Society of Paediatric Infectious Diseases (ESPID) .Dublin, Ireland.2014:Abstract 682.

[26]TURKOVA A, GIACOMET V, GOETGHEBURE T, et al.HCV treatment in children and young adults with HIV/HCV co-infection in Europe[J].J Virus Erad, 2015, 1 (3) :179.

[27]KLEEFELD F, HELLER S, JESSEN H, et al.Effect of interferon-free therapy on cognition in HCV and HCV/HIV infection:a pilot study[J].Neurology, 2017, 88 (7) :713-715.

[28]SOKAL E, NANNINI P.Hepatitis C virus in children:the global picture[J].Arch Dis Child, 2017, 102 (7) :672-675..

[29]HUYSENTRUYT K, STEPHENNE X, VARMA S, et al.Sofosbuvir/ledipasvir and ribavirin tolerability and efficacy in pediatric liver transplant recipients[J].Liver Transpl, 2017, 23 (4) :552-553.

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