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Grand Rounds

What is the Rate of HCV Vertical Transmission?

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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

METHODS:

  • 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

RESULTS:

  • 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)

CONCLUSION:

  • 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

Learn More – Primary Sources:

Overall vertical transmission of HCV, transmission net of clearance, and timing of transmission

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Related ObG Topics:

Is Universal Prenatal HCV Screening Cost-Effective?
What is the Effect of Hepatitis C on Fertility and Pregnancy Outcomes?
Maternal CMV Infection: When is the Highest Risk for Vertical Transmission and Adverse Fetal Outcomes?
Does Amniocentesis or CVS Increase the risk of HIV Vertical Transmission?

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