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Viral load in HCV RNA-positive pregnant women
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Paternoster DM, Santarossa C, Grella P, Palu G, Baldo V, Boccagni P, Floreani
A.
Department of Obstetrics and Gynecology, Institute of Hygiene, University of
Padua, Italy.
Am J Gastroenterol 2001 Sep;96(9):2751-4
OBJECTIVES: The risk of hepatitis C virus (HCV) infection in the newborn is
estimated to be around 5%, but becomes very high in the case of coinfection
with HIV. One of the main factors associated with the vertical transmission
of HCV is the viral load. Our objective was to investigate the behavior of
HCV viral load during pregnancy in relation to HIV coinfection, liver
enzymes, and vertical transmission. METHODS: Three thousand seven hundred
forty-eight women seen consecutively in their first trimester of pregnancy
were screened for HCV infection. Sixty-five were found to be anti-HCV+/HCV
RNA+ and were followed up with clinical and serological assessment (i.e.,
transaminases and quantitative polymerase chain reaction [PCR] for viral
load) in their second and third trimesters and 6 months after delivery. All
were anti-HIV and hepatitis B surface antigen negative. HCV RNA was
12.0+/-19.9 x 10(6) copies/ml in the first trimester and 10.9+/-13.3 x 10(6)
in the second, but increased to 19.5+/-25.1 x 10(6) in the third trimester.
Six months after delivery the viral load returned to the baseline levels; the
changes in viral load did not reach any statistical significance, however.
Transaminases tended toward a reduction from the baseline during the second
and third trimesters, and then an increase in both AST and ALT was recorded 6
months after delivery. However, when the group whose AST/ALT were found
abnormal at the first test was considered, no significant changes were
recorded during the follow-up. The overall rate of vertical transmission was
4.6 CONCLUSIONS: With HCV+ mothers monitoring transaminases during pregnancy
is unnecessary, and testing liver enzymes at the beginning of pregnancy is
sufficient. Qualitative PCR should be done once during the pregnancy, but any
staging of the liver disease should be taken after delivery. Quantitative PCR
testing is expensive and pointless. Any decision for elective cesarean
section in HCV RNA+ mothers should be confirmed by other studies.
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