2215. Polymerase Chain Reaction (PCR) for Detection of Vertically Acquired Hepatitis C Virus (HCV) Infection in Early Infancy

Abstract

BackgroundMany children born to HCV-infected mothers in the U.S. never receive recommended anti-HCV antibody (Ab) screening at age ≥ 18 months. Earlier testing by HCV-RNA PCR might facilitate increased screening, though prior studies using older PCR assays reported unacceptably low sensitivity of one-time PCR testing in infants. We hypothesized that testing at age 2–6 months using modern blood HCV-RNA PCR platforms with enhanced analytical sensitivity and reliability will adequately detect infected infants.MethodsMedical records of vertically exposed infants tested for HCV-RNA at age 2–6 months at Nationwide Children’s Hospital from January 1, 2008 to December 31, 2017 were reviewed. HCV-RNA tests included qualitative (in-house) and quantitative (ARUP reference lab) Cobas Taqman RT-PCR assays (Roche) with lower limits of detection of 1.2–1.9 log10 IU/mL. Diagnostic performance of early PCR screening was determined using a composite gold standard: (1) infected children had ≥ 2 positive PCRs or persistently positive Ab after age 24 months; (2) uninfected children lacked these criteria and required documentation of a negative Ab at a point after age 18 months.ResultsDuring the study period, 639 vertically exposed infants underwent HCV-RNA testing at age 2–6 months. Of these, 24 (3.8%) tested positive, consistent with prior estimates of the vertical transmission rate. Blood HCV-RNA levels were high at screening (median 6.7 log10 IU/mL, range 5.2–7.8 log10 IU/mL), and confirmatory PCR tests were positive in all who had repeat testing (n = 22). Among 615 infants with negative PCR screening, 444 had reached age ≥ 18 months, of whom 144 had undergone Ab testing. Ab tests were negative in 142, while two children had low positive Ab results at 18 months. In both cases, repeat PCR and repeat Ab after age 24 months were negative, suggesting waning maternal Ab rather than true infection. Using the composite gold standard there were 22 true positive, 0 false-positive, 144 true negative, and 0 false negative cases, yielding a sensitivity of 100% (95% CI: 85–100% [Wilson-Brown]).ConclusionThese findings demonstrate that modern blood HCV-RNA PCR assays have excellent sensitivity for detecting vertically infected infants as early as 2–6 months of age and may improve HCV surveillance given the substantial number of children lost to follow-up prior to 18 months Ab screening. Disclosures All authors: No reported disclosures.

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…HCV‐RNA testing can be considered in the first year beginning at 2 months of age, particularly in the setting of concern about loss to follow‐up. Detectable HCV RNA during the first year of life reliably correlates to anti‐HCV positivity at 18 months . Repetitive HCV‐RNA testing prior to 18 months of age is not recommended.…”

“…Detectable HCV RNA during the first year of life reliably correlates to anti-HCV positivity at 18 months. (215) Repetitive HCV-RNA testing prior to 18 months of age is not recommended. Hepatitis C screening is indicated for siblings of children with vertically acquired, chronic HCV infection if born to the same mother and not previously tested for HCV infection.…”

Intrauterine Transmission of Hepatitis C Virus Concomitant with Isolated Severe Fetal Ascites

“…The maternal HCV-IgG antibodies may persist in the infant's blood until 18 months of life. AASLD/IDSA (American Association for the Study of Liver Diseases/Infectious Diseases Society of America) recommends antibody tests at or after 18 months of age or an HCV RNA test after 2 months of age for diagnosis [38,47]. Furthermore, if the child is anti-HCV-antibodies-positive after 18 months, he should be tested for the presence of HCV-RNA after 3 years to confirm a chronic hepatitis C infection [38].…”

“…This test is more expensive but allows an earlier diagnosis of HCV infection in infants. Still, this type of very early diagnosis cannot be proved useful because treatment options are available only after the age of 3 [38,47].…”