The management of HCV infected pregnant women and their children European paediatric HCV network.
ABSTRACT As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children.
A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management. Each recommendation was graded according to the level of evidence.
Although several risk factors for mother-to-child transmission have been identified, none are modifiable and there are currently no interventions available to prevent vertical transmission of HCV. Data on timing of loss of maternal antibodies and reliability of diagnostic tests inform the optimum follow-up schedule for confirmation or exclusion of infection in children born to HCV infected women. Based on the current evidence, routine antenatal screening for HCV should not be introduced and neither elective caesarean section nor avoidance of breastfeeding should be recommended to HCV infected women to prevent mother-to-child transmission of HCV. HCV/HIV co-infected women should follow existing HIV guidelines.
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ABSTRACT: HCV infection transmission rate in infants born to HCV-positive mothers is about 5%. HIV co-infection and high maternal RNA viral load are associated with increased transmission. The only genetic factor previously evaluated is HLA. We investigated the role of genetic factors already associated in adults with HCV infection evolution (HLA-DRB1, MBL2, TNF-alpha, IFN-gamma and IL-10), or liver disease progression (HFE and TGF-beta1). 384 Italian subjects were recruited, including 38 HCV-positive mother/child pairs; 104 infected, non-transmitting mothers with their 114 children; 21 vertically infected children and 69 HCV-exposed, uninfected children. Samples were analysed for previously described gene polymorphisms. Maternal HLA-DRB104 correlated with protection from vertical transmission (p=0.023), while HLA-DRB110 in children was a risk factor (p=0.036). Investigation of concordance degree in HLA-DRB1 locus revealed that a HLA mismatch between mother and child was a protective factor (p=0.017) indicating that alloreactive immune responses are involved in preventing HCV vertical transmission.Virology 06/2009; 390(1):64-70. DOI:10.1016/j.virol.2009.05.007 · 3.28 Impact Factor
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ABSTRACT: The World Health Organization (WHO) and United Nations Programme on HIV/AIDS (UNAIDS) estimated that in the year 2005 there were an additional 700,000 new infections in children, who have been infected through mother-to-child transmission (MTCT). MTCT of HIV-1 accounts for a few hundred infected newborns only in those countries where services for large cover of voluntary counseling and testing of pregnant women and supply of antiretroviral drugs throughout pregnancy with elective Cesarian section and avoidance of breastfeeding are fully established. Intrapartum transmission contributes to approximately 20–25% of infected children, whereas in utero transmission to 5–10% and postnatal transmission to additional 10–15% of cases. The single-dose nevirapine (NVP) regimen has provided the momentum to start MTCT programs in many resource-limited countries; however, regimens using a combination of antiretroviral drugs may be more effective in reducing MTCT rates and limiting resistant mutation development.Perspectives in Medical Virology DOI:10.1016/S0168-7069(06)13006-2
Article: [Viral hepatitis and pregnancy].Felʹdsher i akusherka 01/1989; 53(12):50-3.