Position Paper
Guidelines for the screening and follow-up of infants born to anti-HCV positive mothers

https://doi.org/10.1016/S1590-8658(03)00217-2Get rights and content

Abstract

Hepatitis C virus infection in infancy largely depends on vertical transmission. The transfer of hepatitis C virus from mother to child is almost invariably restricted to children whose mother is viremic, and the rate of transmission seems to be influenced by maternal virus load, although, in the single patient, the levels of viremia cannot be used as predictors of pediatric infection. In fact, the flow-chart for screening children at risk for vertically transmitted hepatitis C virus infection takes into account maternal viremia. In children born to anti-hepatitis C virus antibody positive, hepatitis C virus-RNA negative mothers, alanine aminotransferase and anti-hepatitis C virus should be investigated at 18–24 months of life. If alanine aminotransferase values are normal and anti-hepatitis C virus is undetectable, follow-up should be interrupted. In children born to hepatitis C virus-RNA positive mothers, alanine aminotransferase and hepatitis C virus RNA should be investigated at 3 months of age: (1) hepatitis C virus-RNA positive children should be considered infected if viremia is confirmed by a second assay performed within the 12th month; (2) hepatitis C virus-RNA negative children with abnormal alanine aminotransferase should be tested again for viremia at 6–12 months, and for anti-hepatitis C virus at 18 months; (3) hepatitis C virus-RNA negative children with normal alanine aminotransferase should be tested for anti-hepatitis C virus and alanine aminotransferase at 18–24 months, and should be considered non-infected if alanine aminotransferase is normal and anti-hepatitis C virus undetectable; (4) anti-hepatitis C virus seropositivity beyond the 18th month in a never-viremic child with normal alanine aminotransferase is likely consistent with past hepatitis C virus infection.

Section snippets

Perinatal hepatitis C virus transmission: current knowledge and unsettled issues

Hepatitis C virus (HCV) infection is relatively infrequent among children in developed areas, due to the almost complete disappearance of post-transfusion hepatitis and to the low efficiency of perinatal HCV transmission. In fact, although the recently estimated prevalence of HCV infection among pregnant women in Western Europe is 0.2–2.4% [1], [2], [3], [4], [5], [6], and HCV transmission from an infected mother to her infant is now responsible for most cases of pediatric infection [7], the

Management of HCV infected mothers and of their infants: why are guidelines needed?

There are several considerations supporting the usefulness of guidelines to manage HCV-infected pregnant women and their infants.

  • As stated above, it appears from the current literature that some important issues of perinatal transmission are still a matter of debate; these unsettled issues may be confounding and induce the physician to adopt different behaviors.

  • Although universal screening of pregnant women has not been recommended, physicians should be advised that in particular circumstances

Screening for HCV

Universal HCV screening for pregnant women is not indicated, due to the low prevalence of transmission and the high cost of screening. However, anti-HCV screening is recommended in some circumstances, that should be accurately investigated in the clinical history of mothers, such as:

  • exposure to blood and derivatives before 1990 (in developed countries);

  • past or current intravenous drug abuse;

  • partner with history of intravenous abuse;

  • multiple sexual partners;

  • infection with hepatitis B virus or

Definition of perinatal HCV infection

According to the recent literature [35] infants born to anti-HCV positive mothers are considered HCV-infected when HCV-RNA is detected in peripheral blood by the polymerase chain reaction (PCR) in at least two serum samples during the first year of life and/or when anti-HCV positivity persists beyond 18–24 months of life. At variance with Roberts et al. [35], the present guidelines propose a different flow-chart in relation to the HCV RNA status of the mother.

Conflict of interest statement

There is no conflict of interest.

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    Committee of Hepatology of the Italian Society of Pediatric Gastroenterology and Hepatology: Balli F. (Modena), Barbera C. (Turin), Calacoci M. (Ferrara), Clemente M.G. (Cagliari), Colombo C. (Milan), Crivellaro C. (Monselice, Padua), D’Antiga L. (Padua), De Virgilis S. (Cagliari), Frediani T. (Rome), Giacchino R. (Genoa), Guariso G. (Padua), Iorio R. (Naples), Marcellini M. (Rome), Nebbia G. (Milan), Marrazzi M.G. (Genoa), Torre G. (Bergamo), Valentini P. (Rome), Vegnente A. (Naples), Viola L. (Modena), Zancan L. (Padua).

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