Vertical hepatitis C virus transmission: Main questions and answers

Abstract

Hepatitis C virus (HCV) affects about 3% of the world's population and peaks in subjects aged over 40 years. Its prevalence in pregnant women is low (1%-2%) in most western countries but drastically increases in women in developing countries or with high risk behaviors for blood-transmitted infections. Here we review clinical, prognostic and therapeutic aspects of HCV infection in pregnant women and their offspring infected through vertical transmission. Pregnancy-related immune weakness does not seem to affect the course of acute hepatitis C but can affect the progression of chronic hepatitis C. In fact, postpartum immune restoration can exacerbate hepatic inflammation, thereby worsening the liver disease, particularly in patients with liver cirrhosis. HCV infection increases the risk of gestational diabetes in patients with excessive weight gain, premature rupture of membrane and caesarean delivery. Only 3%-5% of infants born to HCV-positive mothers have been infected by intrauterine or perinatal transmission. Maternal viral load, human immunodeficiency virus coinfection, prolonged rupture of membranes, fetal exposure to maternal infected blood consequent to vaginal or perineal lacerations and invasive monitoring of fetus increase the risk of viral transmission. Cesarean delivery and breastfeeding increases the transmission risk in HCV/human immunodeficiency virus coinfected women. The consensus is not to offer antiviral therapy to HCV-infected pregnant women because it is based on ribavirin (pregnancy category X) because of its embryocidal and teratogenic effects in animal species. In vertically infected children, chronic C hepatitis is often associated with minimal or mild liver disease and progression to liver cirrhosis and hepatocarcinoma is lower than in adults. Infected children may be treated after the second year of life, given the adverse effects of current antiviral agents.

Mechanisms and Prevention of Vertical Transmission in Chronic Viral Hepatitis

“…HCV infection affects 2–3% of the world’s population 5,42,43. In the United States, 1–2% of pregnant women are infected,43–45 with approximately 40,000 children born to HCV-positive mothers each year 44,46.…”

TH17/TH1 Role in Endocrine Disorders among Chronic HCV Infected Patients

“…Diabetes mellitus type 1, formerly known as insulin-dependent diabetes or juvenile diabetes, it is characterized by immunemediated destruction of pancreatic β-cells consequent with interactions between genetic susceptibility and environmental factors and considered one of endocrine related disorders among chronic HCV patients (Tosone et al, 2013).…”

Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women?

“…Although HCV infection acquired at birth may resolve spontaneously, about 25000 to 50000 of children become chronically infected [4][5][6][7] . The prevalence of HCV infection in children is very low in Europe and the United States (0.05%-0.36%) [8] , and increases to between 1.8% and 5.8% in Egypt (which has the highest prevalence of pediatric HCV infection), Sub-Saharan Africa, Mongolia and the Amazon Basin [8] . Consequently, birth to an infected mother is one of most frequent routes of infection, and is comparable to injection drug use, unsafe medical practices and high-risk sexual practices [1] .…”