Interferon alfa-2b and ribavirin: new indication. In children: more risks than in adults.

(1) There is a far lower seroprevalence of hepatitis C virus (HCV) infection in children and adolescents (0.2% to 0.4%) than in adults. In childhood, the principal route of infection is mother-child transmission during pregnancy, while in adolescence transmission is mainly through certain at-risk behaviour (piercing, tattooing and drug injection). In adults with HCV infection, the standard treatment is a combination of peginterferon alfa and ribavirin. (2) 125 children aged 3 to 16 years were treated for 48 weeks in two non comparative trials. HCV RNA was undetectable in plasma in 46% of children six months after treatment cessation (36% for genotype 1 infection, 81% for other genotypes), a proportion similar to that generally seen in adults. It is not known whether the interferon alfa-2b + ribavirin combination slows the progression of histological lesions or prevents clinical complications of HCV infection. (3) Psychological disorders, particularly depression and suicidal tendencies, are the main adverse effects of treatment, especially in children. Growth retardation can also occur, mainly due to gastrointestinal disorders linked to interferon alfa-2b (loss of appetite, nausea and vomiting, diarrhoea). Catch-up growth appears to occur during the six months after treatment cessation. (4) The combination of interferon alfa-2b and ribavirin appears to have similar virological efficacy in children to that seen in adults. Adverse effects, especially those of a psychological nature, remain frequent.