Mother-to-child transmission of hepatitis C virus: Evidence for preventable peripartum transmission
ABSTRACT Little information is available about the timing of mother-to-child transmission of hepatitis C virus (HCV), and no interventions to decrease transmission rates have been identified. We examined the effect of risk factors, including mode of delivery, on the vertical transmission rate.
Data from HCV-infected women and their infants from three hospitals in Ireland and from a British Paediatric Surveillance Unit study of infants born to HCV-infected mothers were used to estimate the vertical transmission rate and risk factors for transmission. We used a probabilistic model using methods that simultaneously estimated the time to HCV-antibody loss in uninfected infants and the diagnostic accuracy of PCR tests for HCV RNA.
441 mother-child pairs from the UK (227) and Ireland (214) were included. 50% of uninfected children became HCV-antibody negative by 8 months and 95% by 13 months. The estimated specificity of PCR for HCV RNA was 97% (95% CI 96-99) and was unrelated to age; sensitivity was only 22% (7-46) in the first month but rose sharply to 97% (85-100) thereafter. The vertical transmission rate was 6.7% (4.1-10.2) overall, and 3.8 times higher in HIV coinfected (n=22) than in HIV-negative women after adjustment for other factors (p=0.06). No effect of breastfeeding on transmission was observed, although only 59 women breastfed. However, delivery by elective caesarean section before membrane rupture was associated with a lower transmission risk than vaginal or emergency caesarean-section delivery (odds ratio 0 [0-0.87], p=0.04, after adjustment for other factors).
The low sensitivity of HCV RNA soon after birth and the finding of a lower transmission rate after delivery by elective caesarean section suggest that HCV transmission occurs predominantly around the time of delivery. If the findings on elective caesarean section are confirmed in other studies, the case for antenatal HCV testing should be reconsidered.
- SourceAvailable from: Sheila M Bird
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- "Maternal transmission has been reduced dramatically by universal offering of antenatal HIV screening and highly active anti-retroviral therapy for maternal HIV disease disease. For HCV carriers, the risk of sexual transmission is low, but around a 6% HCV transmission rate applies from an HCV carrier mother to her infant (Gibb et al., 2000; Hutchinson et al., 2004). (h) Reinfection rates after clearance of HCV carriage: whether patients have a recent history of injection drug use can matter when it comes to sustained clearance of HCV carriage because those who relapse into injecting may become reinfected (Dalgard et al., 2002). "
ABSTRACT: Guidelines for good practice in cost-effectiveness analyses (CEAs) are available from the UK's National Institute for Health and Clinical Excellence, which address the scope of the CEA study, appropriateness of the data used and how to account for model as well as statistical uncertainty. Within these three broad headings, we identify 10 specific issues that may affect materially the CEA of a public health intervention for which injecting drug users are a major target group. The 10 issues relate to injecting drug users' under-representation in randomized controlled trials; their risk of blood-borne viruses—such as human immunodeficiency virus and hepatitis C virus—which have long-term chronic sequelae, their markedly higher age-specific mortality than in the general population and the relapsing–remitting nature of opiate dependence with its associated risk of overdose. We consider how adequately three key UK CEAs accounted for the relevant injecting drug user specific issues that we have highlighted. The three case-studies are antiviral treatment of carriage of hepatitic C virus, opiate substitution therapy and needle and syringe programmes.Journal of the Royal Statistical Society Series A (Statistics in Society) 10/2013; 177(3). DOI:10.1111/rssa.12030 · 1.64 Impact Factor
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- "HCV infection in HIV-1 infected patients is usually caused by drug injection (90%) and blood or blood products transfusion (70%) (3, 4). The major cause of death in HIV-1 infected patients who receive HAART which prevents the progress of HIV-1 infection is the HCV mediated hepatotoxicity (5, 6). In addition, simultaneous HIV-1 infection and HCV-related hepatic diseases, like cirrhosis and hepatocarcinoma, rapidly increases in these patients (7, 8). "
ABSTRACT: HIV-1 and HCV infections are life threatening problems in patients who receive blood products. Serological methods have proven useful in detecting these infections, but there are setbacks that make it challenging to detect these infectious agents. By the advent of Nucleic Acid Testing (NAT) methods, especially in multiplex format, more precise detection is possible. We have developed a multiplex RT-PCR assay for simultaneous detection of HIV-1 and HCV. Primers were designed for highly conserved region of genome of each virus. Using these primers and standard plasmids, we determined the limit of detection, clinical and analytical specificity and sensitivity of the assay. Monoplex and multiplex RT-PCR were performed. Analytical sensitivity was considered to be 100 and 200 copies/ml for HIV-1 and HCV, respectively. High concentration of one virus had no significant effect on the detection of the other one with low concentration. By analysis of 40 samples, clinical sensitivity of the assay was determined to be 97.5%. Using different viral and human genome samples, the specificity of the assay was evaluated to be 100%. The aim of this study was to develop a reliable, rapid and cost effective method to detect HIV-1 and HCV simultaneously. Results showed that this simple and rapid method is perfectly capable of detecting two viruses in clinical samples.Iranian Journal of Microbiology 03/2012; 4(1):8-14.
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- "Important factors contributing to HBV spread include unsafe use of therapeutic injections, blood transfusion,  tattooing, mother to child transmission  and unsafe sexual practices [14,15]. In Pakistan, therapeutic injections administered in health care settings have been identified as major and consistently reported risk factors for HBV. "
ABSTRACT: Hepatitis B virus (HBV) infection is a serious health problem in the developing countries including Pakistan. Various risk factors are responsible for the spread of this infectious disease. Prevalence of HBV infection in apparently suspected individual of Punjab province of Pakistan was analyzed during January 2008 to December 2010. Current study was aimed to investigate the epidemiology and risk factors of HBV infection. Four thousand eight hundred and ninety patients suffering from chronic liver disease were screened for the presence of HBV DNA using qualitative Real Time PCR methodology to confirm their status of infection. A predesigned standard questionnaire was filled for all the patients that included information about the possible risk factors. A total of 4890 ELISA positive patients were screened for Hepatitis B virus infection. Of these 3143 were positive for HBV, includes 68.15% males and 31.85% females. Male were observed to be more frequently infected as compared to the female with a positivity ratio of 2.14: 1. The rate of infection increases with the passage of time in the course of three years. Highest frequency of infection was found in the age of 21-30 was 34.93% followed by 23.83% in 31-40. Only (13.39%) were belonging to the age group 11-20 year. The rate of infection declines with increasing age as shown by age groups 41-50 (16.13%) and 51-60 (7.09%). While children aged 0-10 and very old >60 age groups were very less frequently 1.49% and 1.65% infected respectively. Important risk factors contributing to HBV spread include barber risk (23.60%), blood transfusion (4.04%), History of injection 26.19%, Reuse of syringes 26.60%, dental risk (11.20%) and surgical procedure (4.26%). Among the entire respondents trend sharing personal items was very common. History of injection, barber risk, surgery and dental procedure and reuse of syringes appear as major risk factors for the transmission. Male were more frequently exposed to the risk factors as compared to female. Similarly the younger age group had high rate of infection as compared to the children's and the older age groups. Reuse of syringes', barber risk and History of injection were main risk identified during the present study. To lower HBV transmission rate Government should take aggressive steps towards massive awareness and vaccination programs to decrease the burden of HBV from the Punjab province of Pakistan.Virology Journal 05/2011; 8:225. DOI:10.1186/1743-422X-8-225 · 2.18 Impact Factor