Hepatitis C virus infection during pregnancy and the newborn period – are they opportunities for treatment?

Journal of Viral Hepatitis
Early View (Articles online in advance of print)

M. Arshad 1, S. S. El-Kamary 2,3,4, R. Jhaveri 1,5

Article first published online: 7 JAN 2011
DOI: 10.1111/j.1365-2893.2010.01413.x
© 2011 Blackwell Publishing Ltd

Author Information
1 Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC
2 Department of Epidemiology and Public Health
3 Department of Pediatrics
4 Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
5 Department of Molecular Genetics and Microbiology, Duke University School of Medicine, Durham, NC, USA
* Correspondence: Ravi Jhaveri MD, Division of Pediatric Infectious Diseases, Duke University Medical Center, DUMC 3499, Durham, NC 27710, USA. E-mail: ravi.jhaveri@duke.edu

Abstract

Keywords: hepatitis C virus; infants;pregnancy; treatment; vertical transmission

Summary.  The worldwide prevalence of hepatitis C virus (HCV) infection in pregnant women is estimated to be between 1 and 8% and in children between 0.05% and 5%. While parenteral transmission is still common in children living in developing countries, perinatal transmission is now the leading cause of HCV transmission in developed countries. The absence of an HCV vaccine or approved therapy during pregnancy means that prevention of vertical transmission is still not possible. However, a low vertical transmission rate of 3–5%, a high rate of spontaneous clearance (25–50%) and delayed morbidity have resulted in HCV being overlooked in pregnant women and their infants. Yet a study of the natural history in mothers and children demonstrates that the prognosis of HCV can vary greatly and should be taken seriously. Factors known to increase the risk of perinatal transmission include HIV coinfection and higher maternal viral loads, while elective C-section and withholding breastfeeding have not been demonstrated to reduce vertical transmission. Current guidelines for the diagnosis of persistent perinatal infection require a positive anti-HCV test in infants born to infected mothers after 12 months or two positive HCV RNA tests at least 6 months apart. Current HCV treatment options using pegylated interferon and ribavirin are both unsuitable for use in pregnancy and infancy. However, new agents currently in preclinical phases of development, along with the recently identified association between single-nucleotide polymorphisms within the IL28 gene and treatment response, may serve to create a therapeutic window for these patients

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