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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2021; 27(20): 2474-2494
Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2474
Breakthroughs and challenges in the management of pediatric viral hepatitis
Emanuele Nicastro, Lorenzo Norsa, Angelo Di Giorgio, Giuseppe Indolfi, Lorenzo D'Antiga
Emanuele Nicastro, Lorenzo Norsa, Angelo Di Giorgio, Lorenzo D'Antiga, Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
Giuseppe Indolfi, Department of Neurofarba, Meyer Children's University Hospital of Florence, Florence 50137, Italy
Author contributions: Nicastro E, Norsa L, Di Giorgio A and Indolfi G contributed literature review, manuscript draft, manuscript revision; D'Antiga L contributed manuscript revision.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Emanuele Nicastro, MD, PhD, Consultant, Department of Pediatric Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy. enicastro@asst-pg23.it
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: February 25, 2021
Revised: March 4, 2021
Accepted: April 7, 2021
Article in press: April 7, 2021
Published online: May 28, 2021
Processing time: 112 Days and 21.8 Hours
Abstract

Chronic infections by hepatitis B virus (HBV) and hepatitis C virus (HCV) major causes of advanced liver disease and mortality worldwide. Although regarded as benign infections in children, their persistence through adulthood is undoubtedly of concern. Recent advances in HCV treatment have restored the visibility of these conditions and raised expectations for HBV treatment, which is currently far from being curative. Herein we describe direct-acting antivirals available for pediatric HCV (sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) and their real-world use. A critical review of the HBV pediatric classification is provided. Anti-HBV investigational compounds are reviewed in light of the pathophysiology in the pediatric population, including capsid assembly modulators, antigen secretion inhibitors, silencing RNAs, and immune modifiers. Recommendations for screening and management of immunosuppressed children or those with other risk factors or comorbidities are also summarized.

Keywords: Hepatitis C; Hepatitis B; Direct acting antivirals; Liver cirrhosis; Children

Core Tip: Chronic hepatitis B and C account for substantial morbidity and mortality worldwide. Infection control in children has great clinical and epidemiological implications. This review discusses recent achievements and forthcoming opportunities in the management of pediatric viral hepatitis. Removing barriers to the access to novel direct-acting antivirals, and understanding the relevance of tolerance-breaking new approaches to infection control, are major challenges for pediatric hepatologists.