Hepatitis C — Role of Perinatal Transmission

Abstract

To evaluate the role of perinatal transmission in the spread of hepatitis C virus (HCV), we screened a cohort of pregnant intravenous drug using (IVDU) women for HCV antibody detection; where seropositive HCV RNA detection by polymerase chain reaction (PCR) was found we followed the infants longitudinally for HCV antibody and HCV RNA. Serum prevalence for HCV for this population was 80% with HCV RNA detected in 50%. Recruitment and follow-up over a 3-year period of a cohort of 83 seropositive women, their 91 newborns and 16 siblings of newborns, showed that there had been a 3% perinatal transmission rate with 1 sibling also infected. These positive cases were defined as transient in 1 case (HCV RNA positive by PCR at 1 month, but seronegative and HCV RNA negative at 10 months of age), 2 unevaluable (HCV RNA positive at 2 months of age, but patients lost to follow-up), and 1 chronic infection in a child at 34 months (positive HCV RNA and seropositive 34-month sibling). Maternal HCV RNA levels for those with infected infants was a mean 40-fold greater than those whose babies were uninfected, although this did not reach statistical significance. Of the remaining infants, the majority (93%) had lost passively acquired maternal antibodies by 9 months of age and all by 12 months. Of 18 women who were HCV seropositive and breast feeding (66% of whom were HCV RNA positive in their sera), none had detectable HCV RNA in breast milk. Hence we conclude that transmission of HCV from mother to infant appears to be of low frequency and positivity appears to correlate with maternal circulating viral load.

Risk Factors for Hepatitis C Infection Among Sexually Transmitted Disease‐Infected, Inner City Obstetric Patients

“…Previous work has suggested that pregnant women positive for both HIV and hepatitis C are more likely to transmit hepatitis C to their infants than HIV-negative, HCV-positive mothers 14,15 . A number of investigators have found that increasing viral titers of hepatitis C are associated with a greater risk of vertical transmission [15][16][17][18] , Co-infection with HIV may allow higher hepatitis C viral titers through immunosuppression or there may be some more direct mechanism affecting hepatitis C virus infectivity 19 . Any pregnant woman infected with either HIV or hepatitis C should undergo testing for the other disease.…”

“…A second reason is the risk of vertical transmission. Most authors have found few or no cases of infected children when their mothers had negative or low hepatitis C RNA titers, but significantly greater risks of an affected child in women with high RNA titers on quantitative PCR testing 14,[16][17][18][39][40][41][42][43] . Infants infected with hepatitis C during pregnancy or childbirth have been reported to develop severe clinical hepatitis, jaundice or death 39 .…”

Mother-to-infant transmission of hepatitis C virus

“…Although mother-to-infant transmission occurred across a wide range of maternal viral titers, in 9 studies statistically higher maternal viral titers corresponded to a greater tendency for mother-to-infant transmission 19,33,34,40,[42][43][44][45][46] ; in 9 studies there was no difference. 18,20,27,[35][36][37][38][39]41 Most studies reported mother-to-infant transmission at viral titers beyond the range of 10 5 to 10 6 copies/mL. In one study higher levels of maternal serum HCV RNA also tended to correlate with higher colostrum levels of HCV RNA.…”

“…For example, the 3 studies with highest prevalence (70.1%-95.4%) were limited to intravenous drug users. [17][18][19] Of anti-HCV-positive women, 26.8% to 94.4% tested positive for HCV RNA (mean ϭ 65.5%, SD ϭ 14.6%).…”

“…In 5 studies, including several in which maternal titer of HCV RNA was reported as having no bearing on rate of transmission, the timing of serum collection was unclear. 18,33,[41][42][43]45 …”