Mother-to-Child Transmission of Hepatitis C Virus (HCV) Among HIV/HCV-Coinfected Women

Abstract

Background. Maternal human immunodeficiency virus (HIV) coinfection has been associated with increased hepatitis C virus (HCV) mother-to-child transmission (MTCT). We hypothesized that HCV/HIVcoinfected women with well-controlled HIV disease would not have increased HCV MTCT. Methods. The NISDI Perinatal and LILAC cohorts enrolled HIV-infected pregnant women and their infants in Latin America and the Caribbean. This substudy evaluated the HCV infection status of mothers at participating sites and their live born, singleton infants who had a 6-month postnatal visit by December 31, 2008. Mothers who were anti-HCV-positive, or who had CD4 counts (cells/mm 3 ) <200 with detectable HCV RNA, were considered HCV-infected. All HCV-infected women were tested for HCV RNA. Infants with HCV RNA were considered HCV-infected. Results. Of 1042 enrolled women, 739 (71%) mother-infant pairs met the inclusion criteria. Of the 739 women, 67 (9%) were anti-HCV-positive and 672 anti-HCV-negative [68 (10%) with CD4 counts <200; of these, 3 (4.4%) were HCV RNA-positive]. Therefore, our study population comprised 70 HCV-infected (47 with HCV RNA) and 669 HCV-uninfected women (and their infants). Factors associated with maternal HCV infection included unemployment (odds ratio [OR] = 2.58

Perinatal HCV Transmission Rate in HIV/HCV Coinfected women with access to ART in Madrid, Spain

“…Fewer studies have examined the rates of MTCT of HCV among HIV-coinfected women with well-controlled HIV disease. In a previous study among HIV/HCV-coinfected mothers from Latin American and the Caribbean, a rate of MTCT of HCV of 8.5% (95% CI, 2.8-21.3) was observed [12]. This rate is similar to the rates of MTCT of HCV observed in multicenter studies conducted among HIV-uninfected women [13,14].…”

“…Our results showed a 7.0 (95%CI 3.7-10.4%) transmission rate, which appears to be lower than the rate reported in the literature previous to the extended use of ART [11,12]. We also found that mothers who gave birth to HCV infected children were similar with respect to all HIV-1 infection features, including viral load or time on ART at delivery.…”

“…Since 20% of infants born to HCV infected pregnant mothers may have spontaneous viral clearance, it is important to test for HIV RNA in plasma during the first months of life. Most studies suggest testing for HCV RNA at the age of 2-6 months to early detect HCV infection, along with serum anti-HCV during follow up at 18-24 months in order to verify the persistence or clearance of HCV antibodies [11,12,27]. Since HCV vertical transmission may have a considerable rate of clearance of infection in monoinfected mothers [4] long term follow-up is essential.…”

Review article: direct‐acting antivirals for the treatment of HCV during pregnancy and lactation ‐ implications for maternal dosing, foetal exposure, and safety for mother and child

“…In addition to high maternal HCV viral load, the review states that maternal HIV co‐infection increased the risk of vertical transmission of HCV to around 10% . However, the majority of the co‐infected pregnant women included were not taking antiretroviral therapy, and a recent study suggested that those on antiretroviral therapy have a similar risk of transmitting HCV to those with HCV mono‐infection . The prevalence of HCV and HIV co‐infection among pregnant women varies across settings.…”

New prospects for the treatment and prevention of hepatitis C in children

“…Higher levels of viremia have generally been associated with a greater risk of transmission, but considerable overlap exists between viral loads of transmitting and non-transmitting mothers [49]. Maternal HIV co-infection was previously linked to a 2–4 fold increased risk of HCV vertical transmission [48], but recent evidence suggests that HIV co-infected mothers who are well controlled on highly-active antiretroviral therapy may be no more likely to transmit HCV than HIV-negative mothers [50, 51]. Thus, more work is needed to clarify which women are at the greatest risk of transmitting HCV and potential candidates for interventional trials to limit HCV vertical transmission [23].…”