Spontaneous Clearance of Vertically Acquired Hepatitis C Infection: Implications for Testing and Treatment

Area of Science:

• Pediatric Infectious Diseases
• Hepatology
• Virology

Background:

• Current guidelines recommend hepatitis C virus (HCV) antibody screening at 18 months and RNA testing at 3 years for infants born to viremic mothers.
• These guidelines are partly based on the assumption that 25%-40% of vertically acquired HCV infections spontaneously clear within 4-5 years.

Purpose of the Study:

• To investigate the spontaneous clearance rates of vertically acquired hepatitis C virus (HCV) infection in infants.
• To evaluate the implications of current screening and potential treatment timing on spontaneous clearance and overtreatment.

Main Methods:

• Analysis of data from 179 infants with confirmed vertically acquired HCV infection across three European prospective cohorts.
• Estimation of infection clearance ages using interval censoring and delayed entry methods.
• Investigation of clearance in infants with late-detectable HCV RNA.

Main Results:

• An estimated 65.9% of confirmed HCV infections cleared by age 5 years, with a median clearance time of 12.4 months.
• A significant proportion of infections cleared before they could be confirmed by standard testing.
• Treatment initiated at 6 months, 18 months, or 3 years would result in 59.0%, 39.7%, and 20.9% overtreatment, respectively.

Conclusions:

• The majority of confirmed vertically acquired HCV infections clear spontaneously by age 3 years.
• Current treatment guidelines may lead to significant overtreatment if implemented before age 3.
• Revised infant HCV testing and treatment strategies may be warranted to optimize care and avoid unnecessary interventions.