Grand Rounds

What is the Rate of HCV Vertical Transmission?

BACKGROUND AND PURPOSE:

The hepatitis C virus (HCV) vertical transmission (VT) rate is generally understood to be 5 to 7% with 25 to 40% of infant infections clearing within 5 years
Ades et al. (Clinical Infectious Diseases, 2022) assessed the underlying VT rate and VT clearance at different ages

Secondary analysis of three prospective cohorts
Population
- Children born to HCV-positive mothers
Exposures
- Infected infant: Defined as ever-HCV-infected
- Uninfected infants
Study design
- Clearance rates were used to impute the proportion of uninfected children who had been infected and then cleared before testing negative
- Primary outcome was estimated from data on the proportion of HCV-positive within three days of birth
- Differences between elective caesarean and non-elective caesarean deliveries were accounted for
Primary outcome
- Proportion of VT early in utero, late in utero, and at delivery

1749 children born to HCV-positive women
Overall VT rates
- For HIV-negative mothers: 7.2% (95% Credible interval [CrI], 5.6 to 8)
- For HIV-positive mothers: 12.1% (95% CrI, 8.6 to 16.8)
VT rates net of clearance at 5 years were
- For HIV-negative mothers: 2.4% (95% CrI, 1.1 to 4.1)
- For HIV-positive mothers: 4.1% (95% CrI, 1.7 to 7.3)
Percent of VT by site of occurrence
- Early in utero: 24.8% (95% CrI, 12.1 to 40.8)
- Late in utero: 66.0% (95% CrI, 42.5 to 83.3)
- During delivery: 9.3% (95% CrI, 0.5 to 30.6)

The VT rate for HCV is 7.2%, a rate approximately 24% higher than previously assumed
However, infections that persist beyond 5 years of age are 38% lower than previously assumed

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