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Vertically acquired hepatitis C virus infection: Correlates of transmission and disease progression
Pier-Angelo Tovo1, Carmelina Calitri1, Carlo Scolfaro1
1Pier-Angelo Tovo, Carmelina Calitri, Carlo Scolfaro, Clara Gabiano, Silvia Garazzino, Department of Pediatrics, School of Medicine, University of Torino, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, 10126 Torino, Italy.
Insights
Hepatitis C virus (HCV) mother-to-child transmission (MTCT) is a primary concern in pediatric infections. While some children clear the virus spontaneously, chronic infections are generally mild, with rare severe outcomes.
Area of Science:
- Pediatrics
- Hepatology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection presents varying prevalence globally, with higher rates in resource-limited settings due to unsafe medical practices.
- Mother-to-child transmission (MTCT) is the primary route of pediatric HCV infection, particularly after blood donor screening.
- Maternal HIV co-infection increases HCV MTCT risk, while high maternal viral load is an unpreventable factor.
Purpose of the Study:
- To review the epidemiology, transmission dynamics, and natural history of vertical hepatitis C virus infection in children.
- To discuss risk factors, diagnostic considerations, and management strategies for pediatric HCV.
- To summarize current knowledge on spontaneous viral clearance and long-term outcomes of chronic HCV in children.
Main Methods:
- Literature review of studies on pediatric HCV infection, MTCT, and long-term outcomes.
- Analysis of epidemiological data and risk factors associated with vertical transmission.
- Synthesis of information on spontaneous viral clearance, disease progression, and extrahepatic manifestations.
Main Results:
- HCV MTCT occurs in approximately 5% of cases, with maternal HIV co-infection as a significant risk factor.
- Certain obstetric procedures may increase transmission risk, though evidence is limited; mode of delivery and feeding are not significant factors.
- At least 25% of infected children achieve spontaneous viral clearance (SVC), often within six years, influenced by IL-28B polymorphisms and genotype 3.
- Chronic HCV in children typically shows mild to moderate progression, with rare instances of severe liver fibrosis or failure; autoimmune manifestations are uncommon.
Conclusions:
- HCV MTCT is the main driver of pediatric infection, necessitating careful management during pregnancy and delivery.
- Spontaneous viral clearance is common in children, suggesting a generally favorable long-term prognosis for most with chronic infection.
- Current evidence does not support elective cesarean section or discouraging breastfeeding for HCV-infected mothers.
Abstract:
The worldwide prevalence of hepatitis C virus (HCV) infection in children is 0.05%-0.4% in developed countries and 2%-5% in resource-limited settings, where inadequately tested blood products or un-sterile medical injections still remain important routes of infection. After the screening of blood donors, mother-to-child transmission (MTCT) of HCV has become the leading cause of pediatric infection, at a rate of 5%. Maternal HIV co-infection is a significant risk factor for MTCT and anti-HIV therapy during pregnancy seemingly can reduce the transmission rate of both viruses. Conversely, a high maternal viral load is an important, but not preventable risk factor, because at present no anti-HCV treatment can be administered to pregnant women to block viral replication. Caution is needed in adopting obstetric procedures, such as amniocentesis or internal fetal monitoring, that can favor fetal exposure to HCV contaminated maternal blood, though evidence is lacking on the real risk of single obstetric practices. Mode of delivery and type of feeding do not represent significant risk factors for MTCT. Therefore, there is no reason to offer elective caesarean section or discourage breast-feeding to HCV infected parturients. Information on the natural history of vertical HCV infection is limited. The primary infection is asymptomatic in infants. At least one quarter of infected children shows a spontaneous viral clearance (SVC) that usually occurs within 6 years of life. IL-28B polymorphims and genotype 3 infection have been associated with greater chances of SVC. In general, HCV progression is mild or moderate in children with chronic infection who grow regularly, though cases with marked liver fibrosis or hepatic failure have been described. Non-organ specific autoantibodies and cryoglobulins are frequently found in children with chronic infection, but autoimmune diseases or HCV associated extrahepatic manifestations are rare.
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