Is liver biopsy still needed in children with chronic viral hepatitis?

Liver biopsy is a standard method used for obtaining liver tissue for histopathological evaluation. Since reliable serological and virological tests are currently available, liver biopsy is no longer needed for the etiological diagnosis of chronic hepatitis B and C. However, liver histology remains the gold standard as a prognostic tool, providing information about the liver disease progression(grading of necroinflammatory activity and staging of fibrosis) and serving clinicians in the management and therapeutic decisions. In general, histopathological evaluation is indicated before starting the antiviral treatment. Main limitations of the liver biopsy include its invasive and painful procedure, sampling errors and the inter- and intra-observer variability. In addition, indications for the liver biopsy in pediatric patients with chronic viral hepatitis were questioned recently, and efforts have been made toward the development of non-invasive methods as an alternative to the liver biopsy. The most commonly used methods are novel imaging studies(elastography) and combinations of biomarkers. However, to date, none of these tests was validated in children with chronic viral hepatitis. In this review, we present the current status of the liver biopsy in the management of chronic viral hepatitis B and C in pediatric population, including specific indications, complications, contraindications, problems, limitations, and alternative non-invasive methods.

Management of hepatitis C in children and adolescents during COVID-19 pandemic

In recent years,significant progress in the antiviral treatment of chronic hepatitis C(CHC)has been made due to the development of interferon-free therapies.Three different highly effective,oral direct-acting antiviral(DAA)regimens have been approved for use in adolescents with CHC between the ages of 12-years-old and 17-years-old in Europe.According to the current recommendations,all treatment-naïve and treatment-experienced children with CHC virus infection should be considered for DAA therapy to prevent the possible progression of hepatitis C virus-related liver disease and its complications.However,the novel coronavirus disease 2019 outbreak,which was classified as a pandemic in March 2020,is currently spreading throughout the world,resulting in a disruption of the healthcare system.This disruption is having a negative impact on the care of patients with chronic diseases,including children with CHC.Thus,several efforts have to be made by pediatric hepatologists to prioritize patient care in children with CHC.These efforts include promoting telemedicine in the outpatient setting,using local laboratory testing for follow-up visits,and engaging in the home delivery of DAAs for patients under antiviral therapy whenever possible.