Position PaperGuidelines for the screening and follow-up of infants born to anti-HCV positive mothers
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.
References (40)
- et al.
Prevalence of hepatitis C virus in pregnant women and vertical transmission
Med Clin
(2002) - et al.
Changing epidemiologic pattern of chronic hepatitis C virus infection in Italian children
J Pediatr
(1998) - et al.
Mother-to-infant transmission of hepatitis C virus
Lancet
(1995) - et al.
Human immunodeficiency virus infection as risk factor for mother to child hepatitis C virus transmission; persistence of anti hepatitis C virus in children is associated with the mother’s anti-hepatitis C virus immunoblotting pattern
Hepatology
(1995) - et al.
Vertical transmission of hepatitis C virus infection: usefulness of viraemia detection in HIV1-seronegative hepatitis C virus seropositive mothers
J Pediatr
(1998) - et al.
Mother to child transmission of hepatitis C virus: evidence for preventable peripartum transmission
Lancet
(2000) - et al.
Clinical course of pregnant women with chronic hepatitis C virus infection and risk of mother-to-child hepatitis C virus transmission
Dig Liver Dis
(2001) - et al.
Mother-to-infant transmission of hepatitis C virus
Hepatology
(2001) - et al.
Role of breast feeding in transmission of hepatitis C virus to infants of HCV-infected mothers
J Hepatol
(1998) - et al.
Absence of infection in breast-fed infants born to hepatitis C virus-infected mothers
J Pediatr
(1995)
Hepatitis C virus infection in pregnancy
Br J Obstet Gynaecol
HCV prevalence in pregnant women in the UK
Epidemiol Infect
Prevalence of hepatitis C among pregnant women attending an inner London obstetric department: uptake and acceptability of named antenatal testing
Gut
Prevalence and clinical course of chronic hepatitis C virus (HCV) infection: rate of HCV vertical transmission in a cohort of 15250 pregnant women
Hepatology
Prevalence of hepatitis C virus infection in a cohort of pregnant women in northern Greece and transmission of HCV from mother to child
Eur J Epidemiol
A review of hepatitis C virus (HCV) vertical transmission: risk of transmission to infants born to mothers with and without HCV viraemia or human immunodeficiency virus infection
Int J Epidemiol
Transmission of hepatitis C virus from mothers to infants
N Engl J Med
Perinatal transmission and manifestation of hepatitis C virus infection in a high risk population
Pediatr Infect Dis J
Transmission of hepatitis C virus to infants of human immunodeficiency virus negative intravenous drug-using mothers: rate of infection and assessment of risk factors for transmission
J Viral Hepatitis
Increased risk of maternal infant hepatitis C virus transmission for women coinfected with human immunodeficiency virus type 1
Clin Infect Dis
Cited by (51)
Present and future management of viral hepatitis B and C in children
2020, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :Hepatitis C-RNA screening of infants born to HCV-positive mothers can be performed at the third month of life, followed by another test at 12 months if positive, or at 15 to 18 months, if negative. Anti-HCV antibodies should be checked after 1.5 years of age owing to the persistence of maternal antibodies [18–21]. In the absence of concomitant maternal HIV infection or drugs abuse, the HCV vertical transmission rate is low (∼5%) when compared with HBV transmission [18,19].
Hepatitis B and C
2017, Pediatric Clinics of North AmericaThe management of HCV-infected pregnant women
2010, Annals of HepatologyCitation Excerpt :HCV-RNA-negative children with normal GPT should be tested for anti-HCV antibodies and GPT at 18-24 months of age and should be considered as noninfected if GPT is normal and anti-HCV antibodies are undetectable. Anti-HCV seropositivity beyond the 18th month in a never-viremic child with normal GPT is likely consistent with past hepatitis virus infection.22 Limited data indicate that less than 10% of infected children develop chronic hepatitis, of which less than 5% evolve to cirrhosis.
Hepatitis C Virus Exposure and Infection in the Perinatal Period
2023, Current Pediatric ReviewsClinical practice guidelines for the management of children with mother-to-child transmitted hepatitis C virus infection
2022, Pediatrics International
- 1
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).