HCV Infection During Pregnancy and the Newborn Period
HCV Infection During Pregnancy and the Newborn Period
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.
It is well known that hepatitis C virus (HCV) chronic infection is a major cause of liver disease among adults worldwide and is the leading indication for adult liver transplantation in the United States. There are over 170 million people infected with the virus worldwide, and only half of patients treated with the current standard therapies achieve a sustained viral response. Among the groups less often discussed when considering the burden of HCV infection are pregnant women and their infants. Much remains unknown about the dynamics of chronic HCV infection during and after pregnancy, as well as in the neonatal period. It is clear, however, that chronic HCV infection does have a modified course during these times of tremendous physiological changes. This review will summarize what is known about HCV infection during pregnancy and infancy and offer some perspectives on possible treatment opportunities that may arise during these times as new therapies for HCV become available.
Abstract and Introduction
Abstract
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.
Introduction
It is well known that hepatitis C virus (HCV) chronic infection is a major cause of liver disease among adults worldwide and is the leading indication for adult liver transplantation in the United States. There are over 170 million people infected with the virus worldwide, and only half of patients treated with the current standard therapies achieve a sustained viral response. Among the groups less often discussed when considering the burden of HCV infection are pregnant women and their infants. Much remains unknown about the dynamics of chronic HCV infection during and after pregnancy, as well as in the neonatal period. It is clear, however, that chronic HCV infection does have a modified course during these times of tremendous physiological changes. This review will summarize what is known about HCV infection during pregnancy and infancy and offer some perspectives on possible treatment opportunities that may arise during these times as new therapies for HCV become available.