Vertical transmission of hepatitis C virus
- Eric Goldberg, MD
Eric Goldberg, MD
- Associate Professor of Medicine
- University of Maryland School of Medicine
- Donough J O'Donovan, MD
Donough J O'Donovan, MD
- Clinical Lecturer in Pediatrics
- National University of Ireland, Galway
- Section Editors
- Leonard E Weisman, MD
Leonard E Weisman, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
- Elizabeth B Rand, MD
Elizabeth B Rand, MD
- Section Editor — Pediatric Hepatology
- Professor of Pediatrics
- University of Pennsylvania School of Medicine
- Adrian M Di Bisceglie, MD
Adrian M Di Bisceglie, MD
- Section Editor — Hepatitis C
- Chief of Hepatology
- Saint Louis University School of Medicine
Worldwide, hepatitis B and C are the most common causes of chronic viral hepatitis in children and adults . 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 , 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. Discussion of the effects of pregnancy on HCV infection and HCV infection in children are discussed elsewhere. (See "Pregnancy in women with pre-existing chronic liver disease", section on 'Chronic hepatitis C' and "Hepatitis C virus infection in children".)
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, although it appears that the majority of HCV-infected infants are infected perinatally (either late intrauterine or intrapartum).
The timing of transmission can be reflected by results of polymerase chain reaction (PCR) testing for HCV RNA, which may not be positive until several weeks following infection, when levels of viremia reach the detection threshold. In most infants, HCV RNA levels only become detectable several weeks after birth, suggesting perinatal infection [6-8]. However, detection of HCV RNA within a few days of delivery has also been described, suggesting that in utero infection earlier in pregnancy can also occur.
Vertical transmission of HCV has been documented in numerous studies, but estimates on the rate of transmission vary [9-23]. 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 of vertical transmission is approximately five percent in viremic women, with higher rates in certain subgroups, namely women who are coinfected with HIV. (See 'HIV coinfection' below.).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- TIMING OF TRANSMISSION
- ESTABLISHED RISK FACTORS FOR TRANSMISSION
- HCV viremia
- HIV coinfection
- Maternal intravenous drug use
- Peripheral blood mononuclear cell infection
- POSSIBLE RISK FACTORS FOR TRANSMISSION
- Invasive prenatal testing
- Prolonged rupture of membranes
- Obstetric procedures
- FACTORS NOT ASSOCIATED WITH TRANSMISSION
- HCV genotype
- Mode of delivery
- IL28B genotype
- CLINICAL MANIFESTATIONS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS