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Gastroenterology and Hepatology
Treatment for Hepatitis C which is reversed once treatment is discontinued, although predicted
Treatment for HCV was based on combination treatment with height is not achieved.
43
interferon (3mega-units/m
2
subcutaneously three times each week)
and oral ribavirin 15mg/kg. There are many trials in adults, but a Liver Transplantation
recent open multicentre study in 166 children demonstrated that there Liver transplantation to treat HCV in children is rarely required, but it is
is a sustained viral response (SVR) rate of 45% for all genotypes with a common indication in adults who are suffering from the disease. In
response rates of 70–80% for genotypes 2 and 3,
39
which has been these cases, re-infection of the graft is almost 100% despite prophylactic
maintained for over five years with only one relapse.
40
measures such as treatment with antiviral agents and modification
of immunosuppression.
44
Two recent small clinical trials have shown that 48–50% of paediatric
patients receiving PEG-IFN alfa-2b 1.0–1.5µg/kg/day plus ribavirin Future Therapy for Hepatitis C
15mg/kg/day will attain SVR.
41,42
The response rate is higher (>90%) in Emerging new therapies include protease inhibitors, polymerase
those with genotypes 2 and 3 after a six-month course of treatment inhibitors and cyclophilin inhibitors. Studies in adults with telaprevir, a
compared with patients with genotype 1, as only 50% responded after protease inhibitor, to date have indicated rapid development of viral
12 months.
39
In one study, 13 of 15 patients who attained SVR had a resistance when used as monotherapy but not as combination therapy
complete early virological response (undetectable HCV RNA at week with PEG-IFN and ribavirin.
45
Clinical trials in adults are ongoing with
12), and the remaining two patients who attained SVR had HCV RNA telaprevir and similar agents. The remaining drugs are currently at
levels <600IU/ml at week 12. Treatment with interferon alpha has been an early stage of development, and no studies are planned yet
shown to cause a temporary slowing of growth in pediatric patients in children. ■
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64 EUROPEAN PAEDIATRICS
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