Hepatitis C in children and adolescents: mode of acquisition, natural history and treatment.

Hepatitis C is nowadays mainly acquired in childhood through vertical transmission, while transfusion or surgery related contamination is no more significant. The risk of maternal transmission is related to presence and amount of maternal HCV RNA at the time of delivery. Infection rate is higher in children form HIV positive mothers, and higher if they are themselves co-infected with HIV. Breast milk feeding is not a risk factor, and there is so far no argument to propose cesarean delivery to HCV positive mothers. Treatment with interferon alone is poorly efficient, although pediatric studies remain scarce. Combination treatment using Ribavirin plus interferon, or Ribavirin + pegylated interferon yield a higher success in eradicating viral infection in adults. These treatments can be considered for children in selected cases.