Source / Disclosure
Disclosure: Ades does not report any relevant financial disclosures. Please refer to the study for the relevant financial disclosures of all other authors.
The rate of vertical hepatitis C transmission is about 25% higher than typically estimated, according to a reanalysis of data on more than 1,700 babies born to mothers infected with the virus.
However, the study also found that the rate of spontaneous withdrawal within 5 years of birth tends to be underestimated.
Anthony E. Eds, PhD, MSc, Professor at the Institute of Bristol Population Health Sciences at the University of Bristol Medical School in England, and his colleagues note the “widely accepted” estimate that the risk of vertical transmission of HCV is 5% to 6% in monoinfected women, and 25% in monoinfected women. Up to 40% of infants spontaneously clear their infection within 5 years.
The problem with these estimates is that the methods for calculating them were variable and poorly reported, Ades said.
Aedes and colleagues previously published a study assessing the spontaneous clearance of vertically acquired HCV.
“Both of these studies prompted the need to establish vertical transmission rates along with the timing of mother-to-child transmission of HCV,” Addis told Helios. “Our aim was to inform the design of trials of direct-acting antiviral interventions in pregnancy to prevent transmission to the fetus and newborn.”
Aides and colleagues re-analyzed data from 1,749 children from three prospective studies to estimate overall rates of vertical transmission and withdrawal at different ages. According to the study, they used clearance rates to determine the proportion of uninfected children who became infected and then cleared the infection before testing negative. The researchers then used data on the proportion of positive HCV RNA tests within 3 days of birth to estimate the proportion of early in utero, late in utero and perinatal transmission.
Overall, the study showed that the rate of vertical transmission was 7.2% (95% credible interval). [CI], 5.6–8.9) in mothers who were HIV negative and 12.1% (95% CI, 8.6–16.8) in mothers who were infected with HCV and HIV. The respective rates of withdrawal at 5 years were 2.4% (95% CI, 1.1–4.1) and 4.1% (95% CI, 1.7–7.3).
Aedes and colleagues estimated that 24.8% (95% CI, 12.1–15 40.8) infection occurs early in utero, 66% (95% CI, 42.5–83.3) later in utero and 9.3% (95% CI, 0.5). -30.6) occurs. during delivery.
Based on the data, they concluded that the rate of vertical transmission is about 24% higher than previously thought. However, the risk of infection is still about 38% lower after the age of 5.
According to Aedes, it is recommended that infants at risk of vertical transmission are tested at 18 months, and if tested positive, they are considered infected by age 3, and then tested for confirmation of infection. To test for HCV RNA. If they remain infected, they are treated with DAA.
“However, these recommendations are difficult to implement. Even in the US, a large proportion of at-risk children are lost to follow-up, and many of those who are infected are likely to go untreated,” AIDS said. In countries with low resources, it is unlikely that the recommended management can be implemented at all.
“Development of interventions in pregnancy and approaches to earlier diagnosis and treatment are therefore a priority,” he said.
He said the study’s findings “have no immediate clinical application” but instead clarify the extent of transmission and spontaneous clearance and provide a solid foundation for the design of trials of interventions in pregnancy, and early vs. Postponed treatment trials when age 3 becomes available prior to treatment.