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HIV & High HCV Viral load Increased HCV Perinatal Transmission
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"IS DELIVERY MODE RELATED TO PERINATAL TRANSMISSION OF HEPATITIS C VIRUS (HCV)?"
This study was presented in poster at the 40th annual meeting of EASL (April 2005, Paris).
".....A high HCV viral load at the time of delivery and HIV co-infection are the main risk factors for perinatal transmission of HCV...." note from Jules Levin: these data and other similar previous reports support testing HIV+ pregnant women for HCV as well as for HBV.
E. Marine-Barjoan1, A. Bongain2, A. Berrebi3, C. Laffont4, V. Triolo5, H. Haas5, F. Monpoux5, J. Izopet6, J. Tricoire7, E. Mazurier8, J. Ducos9, C. Pradier10, A. Tran1
1 Hepatogastroenterologie, CHU, Nice, France. 2 Gynecologie Obstetrique, CHU, Nice, France. 3 Gynecologie Obstetrique, CHU, Toulouse, France
4 Virologie, CHU, Nice, France. 5 Pediatrie, CHU, Nice, France. 6 Virologie, CHU, Toulouse, France. 7 Pediatrie, CHU, Toulouse, France. 8 Pediatrie, CHU, Montpellier, France. 9 Virologie, CHU, Montpellier, France. 10 Sante Publique, CHU, Nice, France
Objective: to analyse factors related to perinatal HCV transmission.
Methods: Multi-centre prospective study conducted in HCV-positive mothers in Southern France (Alpes-Maritimes, Haute-Garonne, Herault) between October 1998 and September 2002. Mothers' and children's clinical, HCV/HIV virological characteristics and mode of delivery were recorded. All babies were controlled at M3 by PCR-RNA. They were considered infected if the HCV-RNA was positive with the same genotype as the mother's.
RESULTS
The analysis was conducted in 240 children.
HCV-RNA was positive in 136 mothers and 26% were HIV-positive.
Eighty children were delivered by caesarian section, 80% before onset of labour.
In 63% of cases membranes were intact. Fifty-six percent of these were elective caesarian sections.
Twelve children were HCV-infected (5.6%) at 12 months' follow-up, among whom 3 HCV-RNA became negative at 18 months. Their mothers all had positive HCV-RNA at the time of delivery.
Rate of transmission was significantly higher among HIV/HCV co-infected mothers compared with HCV-infected mothers (11.0% versus 3.8%; p = 0.05).
None of the children were HIV-infected.
There was no statistically significant association between HCV transmission and mode of delivery [5 contaminated children among 45 deliveries by elective caesarian (11%) versus 7 contaminated children born by vaginal delivery (4%)], timing of caesarian section and condition of the membranes.
Among HCV-RNA positive mothers, the risk of HCV transmission was significantly higher for women with a high viral load (median 5.99 log copies/ml versus 5.68 log copies/ml, p < 0.008).
After adjusting for study centre, the risk was higher among HIV-positive women (OR aj: 4.6; 95%CI: 1.006-21.734).
Author Conclusions
A high HCV viral load at the time of delivery and HIV co-infection are the main risk factors for perinatal transmission of HCV.
Caesarian section, whether elective or not, is not associated with a lower risk of HCV transmission.
Spontaneous resolution of viral RNA is possible in children.
We are grateful to Nice University Hospital, the French National Agency for AIDS Research, and the Fondation de France.
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