HCV in children and pregnancy

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Infections of the

pregnant women are less understood than those in other adults. Worldwide, the prevalence of HCV infection in pregnant women and children has been estimated to 1-8% and 0.05-5% respectively.[1] The vertical transmission rate has been estimated to be 3-5% and there is a high rate of spontaneous clearance (25-50%) in the children. Higher rates have been reported for both vertical transmission (18%, 6-36% and 41%).[2][3] and prevalence in children (15%).[4]

In

Cesarean sections are not recommended. Breastfeeding
is considered safe if the nipples are not damaged. Infection around the time of birth in one child does not increase the risk in a subsequent pregnancy. All genotypes appear to have the same risk of transmission.

HCV infection is frequently found in children who have previously been presumed to have non-A, non-B

cryptogenic liver disease.[6] The presentation in childhood may be asymptomatic or with elevated liver function tests.[7] While infection is commonly asymptomatic both cirrhosis with liver failure and hepatocellular carcinoma
may occur in childhood.

Diagnosis

Guidelines for the investigation of babies born to hepatitis C positive mothers have been published.[8]

In children born to hepatitis C virus
alanine aminotransferase and hepatitis C virus antibodies should be investigated at 18-24 months of life. If both the alanine aminotransferase value is normal and hepatitis C virus antibody is not found, follow up should be interrupted.[citation needed
]
In children born to hepatitis C virus RNA positive mothers, alanine aminotransferase and hepatitis C virus RNA should be investigated at 3 months of age. Of these[citation needed]
(1) hepatitis C virus RNA positive children should be considered infected if viremia is confirmed by a second assay performed by the 12th month of age
(2) hepatitis C virus RNA negative children with abnormal alanine aminotransferase should be tested again for viremia at 6-12 months and for antibodies to the hepatitis C virus at 18 months
(3) hepatitis C virus RNA negative children with normal alanine aminotransferase should be tested for antibodies to the hepatitis C virus and have their alanine aminotransferase reestimated at 18-24 months. They should be considered non infected if both the alanine aminotransferase is normal and the antibody levels to the hepatitis C virus are undetectable.
The presence of anti hepatitis C virus antibody beyond the 18th month of age in a never viremic child with normal alanine aminotransferase is likely consistent with past hepatitis C virus infection.[citation needed]

Treatment

Treatment of children has been with interferon and ribavirin.[9] The response to treatment is similar to that in adults.[10] It shows a similar dependence on the genotype. Recurrence after transplant is universal and the outcomes after transplant are usually poor.[11]

In children treatment should be initiated within 12 weeks of the detection of the viral RNA if viral clearance has not occurred within this time.[12] Given the difficulties with establishing a diagnosis of hepatitis C infection in infancy, this recommendation does not apply to infants.[citation needed]

Both pegylated interferon and ribavirin are unsuitable for use in pregnancy and infancy: newer methods of treatment are urgently required.[citation needed]

References

  1. S2CID 35515919
    .
  2. S2CID 23182340
    .
  3. ^
    PMID 9563703
    .
  4. PMID 17320495
    .
  5. S2CID 21207996
    .
  6. PMID 15560066
    .
  7. PMID 15272262
    .
  8. PMID 12870728.{{cite journal}}: CS1 maint: multiple names: authors list (link
    )
  9. PMID 20644626
    .
  10. PMID 22013729
    .
  11. S2CID 38432144
    .
  12. PMID 26624849
    .
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