03729295

April 11, 2021, 19:58

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

The authors seem to deal with an important topic carrying on HCV cure in pediatric patient. The study rational, aim and research motivation are relevant and enough well stated. The bibliographic search method seems to be omitted as well as the search date or period. The findings and/or conclusion answer to the study aim to a degree: “No pediatric studies with the children completing the DAA therapy has revealed evidence of children being unresponsive to DAA therapies. However, for patients with evidence of high-grade fibrosis or cirrhosis, they are still at high risk of developing HCC even after achieving SVR. Solid organ transplant from HCV infected recipients appears to be safe, is associated with excellent outcomes, and should be considered for recipients who would benefit from receiving an organ earlier than they would if they waited for an organ from an uninfected donor. Thus, reducing wait-list associated mortality. While no studies has been performed, based on the efficacy of DAA therapy in children, using HCV-infected donors should be an option. As children will now have access to DAA therapies and potential HCV cure, it is imperative that diagnosis and treatment of this population is not overlooked. A related issue is for patients with chronic liver disease to avoid COVID-19 exposure and infection, by educating patients/parents on the risk and the recommended precautions cure, it is imperative that diagnosis and treatment of this population is not overlooked. This is especially true in rare cases of children with cirrhosis or end stage liver disease secondary to HCV, as there appears to be a higher risk of a severe course of COVID-19. This pandemic should not be a hindrance to continuing the goal of eradication of HCV in the pediatric population. Enhanced screening and awareness efforts and continued education of healthcare providers will improve the outcomes of HCV infection in the pediatric population”. This review may be an informative and useful document for students, clinicians and researchers a fortiori those working in pediatric or hepatology field. However we have some observations to make: The authors noticed in Page 6-13: 1. “Introduction”: you noticed “Non- , Non-B Hepatitis”. I think that you omitted the “A” related to hepatitis A. You should write Non-A,….”. 2. “Epidemiology”: you noticed “All 6 HCV genotypes…”. However, to date 8 genotypes are identified for HCV. 3. “Natural history”: “Albeit uncommon, progression to cirrhosis has been described and…”. This sentence may be reformulated for better readability and comprehension. 4. “Improving the cascade or care”: ”KHAMP has trained primary care providers on HCV epidemiology, diagnosis, management…”. This sentence may be reformulated, because the word "management" means prevention, diagnosis, treatment and monitoring or follow up. 5. “Conclusion”: “…a major impact on health care outcomes for patients of all ages…including…”. In this sentence "...including" may be replaced by "a fortiori".

Firstly, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Secondly, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor, and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for Letter to the Editor. The article processing charge will be exempted for Letter to the Editor. The Letter to the Editor will be published online after peer review. The guidelines for Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor to promote academic communication and lead the development of this discipline.

05121927

April 08, 2021, 03:05

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

Letter to editor: The World Health Organization (WHO) reported that the total number of people currently infected with HCV was approximately 185 million. Compared with adults, children and adolescents are more insidious in HCV infection, which is a public health issue that deserves great attention[1]. The estimated prevalence of HCV infection in children and adolescents is 0.15% globally, corresponding to 3.5 million patients (95% CI 3.1-3.9 million)[2]. Rogers et al comprehensively summarized the current status of HCV infection, clinical treatment strategies, clinical outcomes, diagnosis and screening in children and adolescents and point out the focus of the prevention and control of HCV to achieve the WHO goal of eliminating hepatitis in the future. For the epidemiology of HCV, this review indicated that the prevalence of HCV is increasing year by year in children and adolescents, while it is decreasing in adults. In developing countries with large populations, children’s health care was very worrying, and the prevention and treatment of HCV was even more severe, the prevalence of HCV among street children in Iran was found to be at 2.4% (95% CI: 1.8-3.3)[3]. Although vertical transmission is now the main route of HCV transmission among children and adolescents, in developing countries children who need special medical treatment, such as surgical resection, hemodialysis, and kidney transplantation, suffering higher risk of get HCV infection[4][5]. In addition, as injecting drug use becomes more and more common among children and adolescents, the risk of get HCV infection is gradually increasing. Before the 1990s, children were infected with HCV mainly through blood, blood products, or organ transplantation. Since the implementation of HCV screening of blood donors in various countries in 1992, vertical transmission has become the most important way for children to contract HCV. Although the spontaneous clearance rate of HCV through vertical transmission in children and adolescents was higher than that in adults, Modin et al reported liver disease developed in 32% of patients at a median of 33 years, the incidence of hepatocellular carcinoma was 5%, liver transplant 4% and death occurred in 3%[6]. It is worth that advanced liver disease and decompensated cirrhosis had been identified in children as young as 3 years old and as early as 1 year after infection.[7, 8] At present, the diagnosis of hepatitis C can be achieved through HCV antibody detection and HCV-RNA detection, but the status of patient’s liver damage cannot be grasped. Although the guidelines have not formally recommended the use of non-invasive methods for grading necroinflammatory activity and staging of fibrosis in routine clinical practice in children and adolescents, it can be considered for use before completing performance studies[9, 10]. In terms of treatment, the author comprehensively summarized the application status of direct-acting antiviral regimens in children and adolescents, including the therapeutic effects of different HCV gene types. However, among children and adolescents with HCV, there may be cases of receiving long-term dialysis and for the treatment of the above special populations, special attention should be paid to the possible toxic side effects of drugs. Since direct-acting antiviral regimens were not approved for HCV infected people younger than 18 years old until 2017, the prevention and treatment of HCV in children and adolescents has not received sufficient attention as in adults. Moreover, the focus of the global hepatitis has been on treatment and prevention among adult population, which bears the greatest burden of HCV. However, to realize the goal of eliminating HCV infection, all affected populations, including children and adolescents, should be taken seriously. There was still much work to be done in the prevention of HCV in children and adolescents. On the one hand, there is an urgent need to strengthen sexual education for teenagers and children and avoid drug use. On the other hand, clinical experimental research on the treatment of HCV in pregnant women should be accelerated to minimize the risk of vertical transmission. References: 1 Guidelines for the Screening Care and Treatment of Persons with Chronic Hepatitis C Infection: Updated Version. Geneva: World Health Organization, 2016. 2 Indolfi G, Easterbrook P, Dusheiko G, El-Sayed MH, Jonas MM, Thorne C, Bulterys M, Siberry G, Walsh N, Chang MH, Meyers T, Giaquinto C, Wirth S, Chan PL, Penazzato M. Hepatitis C virus infection in children and adolescents. Lancet Gastroenterol Hepatol 2019 2019-06-01; 4(6): 477-487. 3 Behzadifar M, Gorji HA, Rezapour A, Bragazzi NL. Prevalence of hepatitis C virus among street children in Iran. INFECT DIS POVERTY 2018 2018-10-01; 7(1): 88. 4 Ahmadi SM, Raeessi N. Assessing the prevalence of HBV and HCV infections in children under going hemodialysis and the related risk factors in a children's Medical Center: PS132. Porto Biomed J 2017 2017-09-01; 2(5): 236. 5 Seerat I, Mushtaq H, Rafiq M, Nadir A. Frequency and Associated Risk Factors of Hepatitis B Virus and Hepatitis C Virus Infections in Children at a Hepatitis Prevention and Treatment Clinic in Lahore, Pakistan. Cureus 2020 2020-05-02; 12(5): e7926. 6 Modin L, Arshad A, Wilkes B, Benselin J, Lloyd C, Irving WL, Kelly DA. Epidemiology and natural history of hepatitis C virus infection among children and young people. J HEPATOL 2019 2019-03-01; 70(3): 371-378. 7 Guido M, Bortolotti F, Leandro G, Jara P, Hierro L, Larrauri J, Barbera C, Giacchino R, Zancan L, Balli F, Crivellaro C, Cristina E, Pucci A, Rugge M. Fibrosis in chronic hepatitis C acquired in infancy: is it only a matter of time? AM J GASTROENTEROL 2003 2003-03-01; 98(3): 660-663. 8 Rumbo C, Fawaz RL, Emre SH, Suchy FJ, Kerkar N, Morotti RA, Shneider BL. Hepatitis C in children: a quaternary referral center perspective. J Pediatr Gastroenterol Nutr 2006 2006-08-01; 43(2): 209-216. 9 Fitzpatrick E, Quaglia A, Vimalesvaran S, Basso MS, Dhawan A. Transient elastography is a useful noninvasive tool for the evaluation of fibrosis in paediatric chronic liver disease. J Pediatr Gastroenterol Nutr 2013 2013-01-01; 56(1): 72-76. 10 Lee CK, Perez-Atayde AR, Mitchell PD, Raza R, Afdhal NH, Jonas MM. Serum biomarkers and transient elastography as predictors of advanced liver fibrosis in a United States cohort: the Boston children's hospital experience. J Pediatr 2013 2013-10-01; 163(4): 1058-1064.

Firstly, thank you very much for your professional comments on the article published in World Journal of Gastroenterology. Secondly, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor, and submit it online to World Journal of Gastroenterology at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for Letter to the Editor. The article processing charge will be exempted for Letter to the Editor. The Letter to the Editor will be published online after peer review. The guidelines for Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor to promote academic communication and lead the development of this discipline.

03728767

April 01, 2021, 16:25

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

This is an interesting review that aimed to discuss the HCV impact on health care outcomes for patients of all ages. Overall, the manuscript is very well written and discuss various interesting aspects related to the topic. The role of new DAA antiviral drugs is thoroughly reviewed, with a good side to mention its impact on liver transplantation. Despite, the author forgot to mention either drug interaction with immuno-suppressant nor role of extrahepatic reservoir that proposed to play a role in HCV reinfection. Of note, the paragraph on HCV and coronavirus grabbed my attention and it shades a light on the next future for HCV and HCC patients. At all, I would recommend this review to the scientific community.

Thank you very much for your comments.

02839880

March 27, 2021, 18:31

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

This is a very interesting review that aimed to discuss the natural history, clinical features, and management of HCV in children and adolescents. Overall, the manuscript is very well written and discuss many interesting topics. The importance of new antiviral drugs for HCV is emphasized and deeply reviewed. Of note, the paragraph on coronavirus disease and HCV is interesting and shades a light on what we can expect in the next future. I would surely recommend this review to other colleagues

Thank you very much for your comments.