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Vertical transmission of hepatitis C virus

Authors
Eric Goldberg, MD
Sanjiv Chopra, MD, MACP
Donough J O'Donovan, MD
Section Editors
Leonard E Weisman, MD
Elizabeth B Rand, MD
Sheldon L Kaplan, MD
Adrian M Di Bisceglie, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

Worldwide, hepatitis B and C are the most common causes of chronic viral hepatitis in children and adults [1]. In industrialized nations, because of vaccination programs against hepatitis B, hepatitis C virus (HCV) has become the primary cause of chronic viral hepatitis in children [2], with vertical transmission becoming the leading source of infection [3-5]. Vertical transmission refers to viral transmission from the mother to the infant during pregnancy, at the time of delivery, or during the first 28 days after birth.

The issues surrounding vertical transmission of HCV are reviewed here. Other topics related to the epidemiology and transmission of HCV, screening for HCV, the management of pregnant women with chronic liver disease, and a general discussion of HCV infection in children are discussed separately. (See "Epidemiology and transmission of hepatitis C virus infection" and "Screening for chronic hepatitis C virus infection" and "Initial prenatal assessment and first-trimester prenatal care" and "Pregnancy in women with pre-existing chronic liver disease", section on 'Chronic hepatitis C' and "Hepatitis C virus infection in children" and "Diagnosis and evaluation of chronic hepatitis C virus infection".)

TIMING OF TRANSMISSION

The mechanisms underlying vertical transmission of HCV are poorly understood. Intrauterine transmission during pregnancy and infection at the time of delivery are both possible. Polymerase chain reaction (PCR) testing for HCV RNA may not be positive until several weeks following infection, when levels of viremia reach the detection threshold. The fact that HCV ribonucleic acid (RNA) has been detected in the serum of newborn infants within a few days of delivery suggests that infection during pregnancy can occur [6-8] because infection that occurred at the time of delivery would not be detectable for several weeks. However, despite the fact that transmission during pregnancy can occur, in the majority of infants infected with HCV, HCV RNA levels only become detectable several weeks after birth, suggesting perinatal infection (either late intrauterine or intrapartum).

INCIDENCE

Vertical transmission of HCV has been documented in numerous studies [9-23]. However, estimates on the rate of vertical transmission of HCV vary significantly. Some of the variability in estimates of may be the result of differences in study methodologies and maternal populations studied. Overall, it appears that the risk is approximately five percent in viremic women, with higher rates in certain subgroups, namely women who are coinfected with HIV. (See 'HIV coinfection' below.)

The risk has been estimated in several reviews of observational data. One meta-analysis included 20 studies of pregnant women with chronic HCV infection (HCV antibody and RNA positive) that determined transmission by laboratory testing of the infant after at least 18 months of age [24]. The pooled transmission rate was 5.8 percent (95% CI 4.2-7.8) among women with HCV monoinfection and 10.8 percent (95% CI 7.6-15.2) among those with HCV/HIV coinfection. These results were generally consistent with a prior systematic review, in which the overall adjusted rate of vertical HCV transmission from anti-HCV antibody positive women was 1.7 percent, but 4.3 percent among HCV viremic women and up to 19.4 percent in HCV/HIV co-infected women [25].

                 

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