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Hepatitis C virus infection in infants whose mothers took street drugs intravenously
P S Weintrub1, G Veereman-Wauters, M J Cowan
1Department of Pediatrics, University of California, San Francisco.
Insights
Hepatitis C virus (HCV) can transmit from mothers to infants. While maternal antibodies often clear, some infants develop persistent HCV infection, particularly those coinfected with HIV, requiring monitoring beyond 12 months.
Area of Science:
- Virology
- Immunology
- Pediatrics
Background:
- Assessing mother-to-infant hepatitis C virus (HCV) transmission risk.
- Studying infants born to mothers with a history of intravenous illicit drug use.
- Utilizing enzyme-linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA) for anti-HCV antibody detection.
Observation:
- Maternal anti-HCV antibodies were detected in 40% of infants in the first four months.
- Anti-HCV cleared in most infants by 15 months, but persisted in one.
- Three initially seronegative infants showed persistent anti-HCV, with two having transient positivity.
Findings:
- RIBA confirmed true HCV infection in infants with persistent anti-HCV.
- Elevated transaminase levels and HIV coinfection were noted in infants with persistent HCV.
- Vertically transmitted HCV may cause hepatitis in infants, especially those with HIV coinfection.
Implications:
- Neonates at risk for HCV infection require monitoring beyond 12 months.
- Interpretation of anti-HCV antibody tests in infants needs further investigation.
- Hepatitis C virus transmission and coinfection pose significant risks in vulnerable infant populations.
Abstract:
To assess the risk of transmission of hepatitis C virus from mother to infant during pregnancy or at delivery, we measured the antibody to hepatitis C virus (anti-HCV) by an enzyme-linked immunosorbent assay (ELISA) and a recombinant immunoblot assay (RIBA) in serum from 43 infants whose mothers took illicit drugs intravenously. Passively transmitted maternal anti-HCV was detected in 17 (40%) of the 43 infants tested with the ELISA during the first 4 postnatal months. Ten of these initially seropositive infants were followed to 15 months of age or beyond; anti-HCV cleared from nine infants and persisted in one. Among 24 initially seronegative infants, three (12.5%) showed persistent anti-HCV at 6, 11, and 18 months of age, respectively. The remaining two infants were initially tested with ELISA at 6 and 15 months of age; both were transiently seropositive, but anti-HCV disappeared by 12 and 24 months of age, respectively. Among the 17 infants with maternal antibody, nine with ELISA reactions greater than 2.5 optical density units were reactive by RIBA: the eight with weaker reactivity by ELISA were nonreactive by RIBA. When serum samples from the four infants who showed persistent reactivity by ELISA were tested with RIBA, one reacted to both antigens displayed by RIBA (C-100 and 5-1-1), one reacted to the 5-1-1 antigen only, and two were nonreactive. Serum transaminase values were elevated in three of these four infants; all four were also infected with human immunodeficiency virus. The results indicate that vertically transmitted hepatitis C virus may be a cause of hepatitis in infants, especially those coinfected with human immunodeficiency virus. Neonates at risk of hepatitis C virus infection should be monitored beyond 12 months of age. The interpretation of tests for anti-HCV antibody during infancy requires further investigation.