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Mother-to-infant transmission of hepatitis C virus
1III Paediatric Clinic, Department of Paediatrics, University of Florence, Meyer Hospital, Italy. m.resti@ao-meyer.toscana.it
Insights
Hepatitis C virus (HCV) is a leading cause of chronic liver disease in children. Mother-to-infant transmission is the primary infection route, with HIV coinfection significantly increasing HCV risk.
Area of Science:
- Hepatology
- Infectious Diseases
- Pediatrics
Background:
- Hepatitis B virus (HBV) vaccination has shifted the leading cause of infectious chronic liver disease in children to hepatitis C virus (HCV).
- With improved blood screening, mother-to-infant transmission is now the predominant route for pediatric HCV infection.
- Perinatally acquired HCV infection often progresses to chronicity, though liver disease is typically mild in childhood.
Purpose of the Study:
- To review risk factors for vertical transmission of hepatitis C virus.
- To understand the impact of host and viral factors on mother-to-infant HCV transmission.
- To discuss the long-term outcomes of childhood HCV infection.
Main Methods:
- Literature review of studies on mother-to-infant hepatitis C virus transmission.
- Analysis of viral factors (viral load, genotype, quasispecies) and host factors (HIV coinfection, drug abuse, delivery mode, breastfeeding).
- Examination of chronicity rates and disease progression in perinatally infected children.
Main Results:
- The rate of mother-to-infant HCV transmission is approximately 5% in anti-HCV positive, anti-HIV negative mothers.
- Hepatitis C virus transmission risk is 3-5 times higher in mothers coinfected with HIV.
- Maternal drug abuse is a significant host-related risk factor; breastfeeding and vaginal delivery do not appear to influence transmission rates.
- High viral load is a potential risk factor, while HCV genotype's role is unclear; quasispecies importance is hypothesized but unproven.
Conclusions:
- Mother-to-infant transmission is the primary route of HCV infection in children, with HIV coinfection posing a substantial increased risk.
- Viral load and maternal HIV coinfection are key factors influencing vertical HCV transmission.
- Most perinatally infected children develop chronic HCV, but liver disease progression is generally slow during childhood.
Abstract:
Since the programme of the hepatitis B virus vaccination started, hepatitis C virus has become the most significant cause of chronic liver disease of infectious aetiology in paediatric age. After the introduction of hepatitis C virus screening of blood units, vertical transmission seems to now be the most common route of hepatitis C virus infection in children. According to studies on infants born to anti-hepatitis C virus positive women, the rate of mother-to-infant transmission is about 5% when the mother is anti-hepatitis C virus positive and anti-HIV negative, but the risk is three-five times higher when the mother is coinfected with HIV. Both viral and host-related factors are of importance as risk factors in vertical hepatitis C virus transmission. Among the first, only viral load has been demonstrated by some authors as a relevant risk factor while genotype seems not to be influent. The importance of quasispecies has been hypothesized but not yet clarified. Among host-related factors, beyond maternal HIV coinfection, maternal drug abuse has certainly an important role. Other factors such as breast feeding and vaginal delivery do not seem to influence the rate of vertical transmission. Progression to chronicity occurs in the majority of perinatally infected children, although hepatitis C virus associated liver disease is usually mild throughout infancy and childhood.